Antibiotic Overuse and Stewardship at Hospital Discharge: The Reducing Overuse of Antibiotics at Discharge Home Framework

doi:10.1093/cid/ciab842

Review

. 2022 May 3;74(9):1696-1702.

doi: 10.1093/cid/ciab842.

Antibiotic Overuse and Stewardship at Hospital Discharge: The Reducing Overuse of Antibiotics at Discharge Home Framework

Valerie M Vaughn^{1

2

3}, Adam L Hersh⁴, Emily S Spivak⁵

Affiliations

¹ Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
² Division of Health System Innovation and Research, Department of Population Health Science, University of Utah School of Medicine, Salt Lake City, Utah, USA.
³ Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA.
⁴ Division of Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
⁵ Division of Infectious Diseases, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.

PMID: 34554249
PMCID: PMC9070833
DOI: 10.1093/cid/ciab842

Review

Antibiotic Overuse and Stewardship at Hospital Discharge: The Reducing Overuse of Antibiotics at Discharge Home Framework

Valerie M Vaughn et al. Clin Infect Dis. 2022.

. 2022 May 3;74(9):1696-1702.

doi: 10.1093/cid/ciab842.

Authors

Valerie M Vaughn^{1

2

3}, Adam L Hersh⁴, Emily S Spivak⁵

Affiliations

¹ Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
² Division of Health System Innovation and Research, Department of Population Health Science, University of Utah School of Medicine, Salt Lake City, Utah, USA.
³ Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA.
⁴ Division of Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
⁵ Division of Infectious Diseases, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.

PMID: 34554249
PMCID: PMC9070833
DOI: 10.1093/cid/ciab842

Abstract

Though opportunities exist to improve antibiotic prescribing across the care spectrum, discharge from acute hospitalization is an increasingly recognized source of antibiotic overuse. Antimicrobials are prescribed to more than 1 in 8 patients at hospital discharge; approximately half of which could be improved. Key _targets for antibiotic stewardship at discharge include unnecessary antibiotics, excess duration, avoidable fluoroquinolones, and improving (or avoiding) intravenous antibiotic therapy. Barriers to discharge antibiotic stewardship include the perceived "high stakes" of care transitions during which patients move from intense to infrequent observation, difficulties in antibiotic measurement to guide improvement at discharge, and poor communication across silos, particularly with skilled nursing facilities. In this review, we discuss what is currently known about antibiotic overuse at hospital discharge, key barriers, and _targets for improving antibiotic prescribing at discharge and we introduce an evidence-based framework, the Reducing Overuse of Antibiotics at Discharge Home Framework, for conducting discharge antibiotic stewardship.

Keywords: antibiotic stewardship; care transition; discharge; infection.

PubMed Disclaimer

Figures

**Figure 1.**
The Reducing Overuse of Antibiotics at Discharge Home Framework for reducing overuse of antibiotics at discharge. Abbreviations: CPOE, computerized order entry; EHR, electronic health record.

See this image and copyright information in PMC

Cited by

Antimicrobial prescription at the time of discharge from a tertiary-care hospital in India: A potential _target for reducing use at the community level.
Gupta S, Gunjiyal J, Varma S, Malhotra R, Shrivastav S, Parveen R, Mathur P. Gupta S, et al. Antimicrob Steward Healthc Epidemiol. 2022 Dec 9;2(1):e196. doi: 10.1017/ash.2022.308. eCollection 2022. Antimicrob Steward Healthc Epidemiol. 2022. PMID: 36712474 Free PMC article.
Characterization of antibiotic overuse for common infectious disease states at hospital discharge.
Zodrow R, Olson A, Willis S, Grauer D, Klatt M. Zodrow R, et al. Antimicrob Steward Healthc Epidemiol. 2023 Dec 12;3(1):e229. doi: 10.1017/ash.2023.497. eCollection 2023. Antimicrob Steward Healthc Epidemiol. 2023. PMID: 38156229 Free PMC article.
Antimicrobial Stewardship Teams in Veterans Affairs and Nonfederal Hospitals in the United States: A National Survey of Antimicrobial Stewardship Practices.
Hawes AM, Greene MT, Ratz D, Fowler KE, Kendall RE, Patel PK. Hawes AM, et al. Open Forum Infect Dis. 2024 Jan 8;11(1):ofad620. doi: 10.1093/ofid/ofad620. eCollection 2024 Jan. Open Forum Infect Dis. 2024. PMID: 38213633 Free PMC article.
A Statewide Collaborative Quality Initiative to Improve Antibiotic Duration and Outcomes in Patients Hospitalized With Uncomplicated Community-Acquired Pneumonia.
Vaughn VM, Gandhi TN, Hofer TP, Petty LA, Malani AN, Osterholzer D, Dumkow LE, Ratz D, Horowitz JK, McLaughlin ES, Czilok T, Flanders SA. Vaughn VM, et al. Clin Infect Dis. 2022 Aug 31;75(3):460-467. doi: 10.1093/cid/ciab950. Clin Infect Dis. 2022. PMID: 34791085 Free PMC article.
Pharmacist gender and physician acceptance of antibiotic stewardship recommendations: An analysis of the reducing overuse of antibiotics at discharge home intervention.
Vaughn VM, Giesler DL, Mashrah D, Brancaccio A, Sandison K, Spivak ES, Szymczak JE, Wu C, Horowitz JK, Bashaw L, Hersh AL. Vaughn VM, et al. Infect Control Hosp Epidemiol. 2023 Apr;44(4):570-577. doi: 10.1017/ice.2022.136. Epub 2022 Jun 7. Infect Control Hosp Epidemiol. 2023. PMID: 35670587 Free PMC article.

See all "Cited by" articles

References

1. Brunisholz KD, Stenehjem E, Hersh AL, et al. . Antibiotic prescribing in urgent care: implementing evidence-based medicine in a rapidly emerging health care delivery setting. Qual Manag Health Care 2020; 29:46–7. - PubMed
1. Vaughn VM, Gandhi TN, Chopra V, et al. . Antibiotic overuse after hospital discharge: a multi-hospital cohort study. Clin Infect Dis 2020; doi:10.1093/cid/ciaa1372. - DOI - PMC - PubMed
1. Moehring RW, Hazen KC, Hawkins MR, Drew RH, Sexton DJ, Anderson DJ. Challenges in preparation of cumulative antibiogram reports for community hospitals. J Clin Microbiol 2015; 53:2977–82. - PMC - PubMed
1. Jenkins TC, Hulett T, Knepper BC, et al. . A statewide antibiotic stewardship collaborative to improve the diagnosis and treatment of urinary tract and skin and soft tissue infections. Clin Infect Dis 2018; 67:1550–8. - PubMed
1. Dyer AP, Dodds Ashley E, Anderson DJ, et al. . Total duration of antimicrobial therapy resulting from inpatient hospitalization. Infect Control Hosp Epidemiol 2019; 40:847–54. - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions

Grants and funding

K08 HS026530/HS/AHRQ HHS/United States

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

[1] Brunisholz KD, Stenehjem E, Hersh AL, et al. . Antibiotic prescribing in urgent care: implementing evidence-based medicine in a rapidly emerging health care delivery setting. Qual Manag Health Care 2020; 29:46–7. - PubMed

[2] Brunisholz KD, Stenehjem E, Hersh AL, et al. . Antibiotic prescribing in urgent care: implementing evidence-based medicine in a rapidly emerging health care delivery setting. Qual Manag Health Care 2020; 29:46–7. - PubMed

[3] Vaughn VM, Gandhi TN, Chopra V, et al. . Antibiotic overuse after hospital discharge: a multi-hospital cohort study. Clin Infect Dis 2020; doi:10.1093/cid/ciaa1372. - DOI - PMC - PubMed

[4] Vaughn VM, Gandhi TN, Chopra V, et al. . Antibiotic overuse after hospital discharge: a multi-hospital cohort study. Clin Infect Dis 2020; doi:10.1093/cid/ciaa1372. - DOI - PMC - PubMed

[5] Moehring RW, Hazen KC, Hawkins MR, Drew RH, Sexton DJ, Anderson DJ. Challenges in preparation of cumulative antibiogram reports for community hospitals. J Clin Microbiol 2015; 53:2977–82. - PMC - PubMed

[6] Moehring RW, Hazen KC, Hawkins MR, Drew RH, Sexton DJ, Anderson DJ. Challenges in preparation of cumulative antibiogram reports for community hospitals. J Clin Microbiol 2015; 53:2977–82. - PMC - PubMed

[7] Jenkins TC, Hulett T, Knepper BC, et al. . A statewide antibiotic stewardship collaborative to improve the diagnosis and treatment of urinary tract and skin and soft tissue infections. Clin Infect Dis 2018; 67:1550–8. - PubMed

[8] Jenkins TC, Hulett T, Knepper BC, et al. . A statewide antibiotic stewardship collaborative to improve the diagnosis and treatment of urinary tract and skin and soft tissue infections. Clin Infect Dis 2018; 67:1550–8. - PubMed

[9] Dyer AP, Dodds Ashley E, Anderson DJ, et al. . Total duration of antimicrobial therapy resulting from inpatient hospitalization. Infect Control Hosp Epidemiol 2019; 40:847–54. - PubMed

[10] Dyer AP, Dodds Ashley E, Anderson DJ, et al. . Total duration of antimicrobial therapy resulting from inpatient hospitalization. Infect Control Hosp Epidemiol 2019; 40:847–54. - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Antibiotic Overuse and Stewardship at Hospital Discharge: The Reducing Overuse of Antibiotics at Discharge Home Framework

Affiliations

Antibiotic Overuse and Stewardship at Hospital Discharge: The Reducing Overuse of Antibiotics at Discharge Home Framework

Authors

Affiliations

Abstract

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical