Disclosures: The authors report no relevant financial disclosures.
October 30, 2021
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Researchers find ‘clear targets’ for antibiotic stewardship in mental health units

Disclosures: The authors report no relevant financial disclosures.
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Approximately 10% of patients in mental health units at more than 100 Veterans Affairs hospitals were exposed to antibiotics, researchers reported — much lower than levels reported in acute-care hospitals.

However, researchers did find opportunities for stewardship, noting that UTIs were frequently diagnosed and treated in mental health units without documented findings supporting the diagnosis.

Antibiotic pills
One in every 10 patients in mental health units at more than 100 Veterans’ Affairs hospitals was exposed to antibiotics. Source: Adobe Stock.
Daniel J. Livorsi

“Some antibiotic stewardship colleagues at other Veterans Affairs hospitals have told me that there is a lot of antibiotic overuse on their hospital's mental health units, and I have noted similar patterns at the hospitals where I work.” Daniel J. Livorsi MD, MSc, an infectious disease physician and assistant professor of internal medicine-infectious diseases at the University of Iowa Carver College of Medicine, told Healio. “Because of this, we thought it would be worthwhile to evaluate antibiotic use among this patient population in a more systematic manner.”

Livorsi and colleagues collected administrative data on all patients admitted to an inpatient mental health ward in the Veterans Health Administration between Jan. 1, 2016, and Dec. 31, 2018, including data from inpatient mental health units at 111 medical centers but excluding substance abuse rehabilitation units and domiciliaries. They searched medication records and outpatient medication files for inpatient and post-discharge antibiotics.

Overall, there were 252,588 patient admissions in the 111 mental health units. During the study period, 10.9% of patients received an antibiotic while hospitalized in the mental health unit. The most common diagnoses associated with an antibiotic prescription were UTIs (18.3%), skin and soft-tissue infections (10.9%) and acute respiratory tract infections (7.1%), including acute bronchitis, pharyngitis, sinusitis and upper respiratory tract infections, Livorsi and colleagues reported.

The most commonly prescribed agents were trimethoprim-sulfamethoxazole, cephalosporins, tetracyclines, anti-influenza medications and fluoroquinolones, with 7 days being the median total duration of therapy among patients who received antibiotics, including as inpatients and after discharge, according to the study.

The researchers noted that antibiotic prescribing decisions were not just being made by mental health providers but also providers from internal medicine and the ED, suggesting “that efforts to improve antibiotic prescribing in mental health units needs to have a broad target audience,” Livorsi said.

“Antibiotics are used far less frequently in mental health units than other parts of a hospital,” Livorsi said. “However, if an antibiotic stewardship program has the time and the resources, there may be some clear targets for both diagnostic and antibiotic stewardship in the hospital's mental health unit.”