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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 Hersh  4 , Emily S Spivak  5
Affiliations
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. .

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.

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Figure 1.
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.
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