A study of Veterans Affairs (VA) hospitals found that collaboration between antimicrobial stewardship physicians and pharmacists and use of local antibiotic prescribing guidelines were associated with less antibiotic use at discharge, researchers reported today in Infection Control & Hospital Epidemiology.
Using data from the Veterans Health Administration, researchers from the Iowa City VA Health Care System evaluated post-discharge oral antibiotic prescribing at 123 VA hospitals from May 2020 to May 2021 with a risk-adjusted metric that categorized hospitals into three groups: high-performing (less frequent prescribing of antibiotics at discharge and shorter antibiotic courses), low-performing (more frequent antibiotic prescribing at discharge and longer antibiotic courses), and intermediate-performing. They then used responses from a mandatory antibiotic stewardship survey to determine the association between hospital characteristics and performance.
Stewardship processes critical to performance
Of the 396,909 patient admissions across the 123 hospitals, 17.2% received post-discharge antibiotics, with a median duration of 6 days. Based on the risk-adjusted metric, 37 hospitals (30.1%) were high-performing, 22 (17.9%) were low-performing, and 64 (52%) were intermediate-performing. The two stewardship processes associated with metric performance were more frequent interactions between stewardship champions (70.3% vs. 22.7% at high- and low-performing sites, respectively) and education of inpatient providers on stewardship principles within the past year (97.3% vs 77.3% at high- and low-performing sites, respectively).
A multinomial logistic regression model found that low-performing hospitals were less likely than high-performing hospitals to report interactions between their stewardship physician and stewardship pharmacist every day or several times per week (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.03 to 0.55), and use local antibiotic prescribing guidelines for common infections (OR, 0.21; 95% CI, 0.05 to 0.93).
The study authors note that both components are recommended in the Centers for Disease Control and Prevention's Core Elements for Hospital-Based Stewardship Programs.
"Physician engagement likely provides credibility to initiatives to reduce antibiotic overuse at discharge, while local guidelines provide an easy reference for determining duration of therapy," they wrote. "While there may be many ways to reduce antibiotic overuse at this transition of care, these two features seem to be important strategies for success."`
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