A multifaceted outpatient antibiotic stewardship intervention implemented at Mayo Clinic hospitals was associated with reduced unnecessary antibiotic prescribing for upper respiratory infections (URIs), researchers reported today in Open Forum Infectious Diseases.
The intervention, implemented across Mayo Clinic facilities in Minnesota, Wisconsin, Florida, and Arizona in July 2020, aimed to reduce antibiotic use for Tier 3 URI syndromes, which are defined as URIs for which antibiotics are never indicated.
Specific interventions were standardized provider education, development of a syndrome-based, pre-populated ambulatory panel, peer comparison reporting, and a provider-facing data dashboard to facilitate self-auditing of cases in which antibiotics were flagged as unnecessary. The intervention also included a patient-facing antibiotic commitment poster and handouts for patients promoting symptomatic management.
To evaluate the effect of the intervention, Mayo Clinic researchers measured the percentage of Tier 3 encounters that resulted in an antibiotic prescription before and after implementation, along with the rate of repeat respiratory-related healthcare encounters within 14 days of the index visit. They also looked at factors associated with persistent unnecessary prescribing.
Unnecessary antibiotic prescriptions nearly cut in half
A total of 165,658 Tier 3 encounters—96,125 in the pre- and 69,533 in the post-intervention period—were included in the analysis. Baseline patient characteristics were similar in the two periods, with approximately 45% of encounters involving patients aged 18 and under.
Following the intervention, the prescribing rate for Tier 3 encounters decreased from 21.7% to 11.2% overall (a 48.4% relative reduction), amounting to roughly 7,300 unnecessary antibiotic prescriptions avoided. Significant reductions were observed in all geographic regions and departments. The largest improvement was observed in urgent care (a 51.8% relative reduction in prescribing).
Repeat 14-day respiratory healthcare contact was less common when an antibiotic was prescribed in the overall cohort (6.9% antibiotics vs 9.7% no antibiotics) but was lower in the no-antibiotics patients post-intervention (9.9.% vs 9.4%). Multivariable models indicated that increasing patient age, Charlson comorbidity index, and primary diagnosis selected were the most important factors associated with persistent unnecessary antibiotic prescribing.
"Our study adds to mounting evidence that targeted outpatient antibiotic stewardship programs are effective at reducing unnecessary or inappropriate antibiotic prescribing for URIs," the study authors wrote.