Infectious Disease

Medical short stay units “overlooked” as a source of antibiotic overuse

September 14, 2021

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The authors do not report any relevant financial information.

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A study of 100 patients discharged from two short-term medical stays showed that 78% of their antibiotic prescriptions included at least one type of antibiotic overuse and 28% multiple types, the researchers reported.

“In our facility and in many other locations, antibiotic prescribing upon discharge from acute care is increasingly recognized as a source of overuse and is being targeted by stewardship efforts.” Nathaniel S. Soper, MD, clinical instructor in the Department of Hospital Medicine at the University of Michigan, Healio said. “We have seen significant improvements in antibiotic prescribing at discharge through recent stewardship efforts at our facility. However, the prescription of antibiotics for discharge has not been evaluated for medical short stay units. “

According to Soper, short-term medical units are being used more and more frequently in various facilities. Their unique environment presents some additional potential barriers to proper antibiotic prescribing as frequent handovers are combined with institutional pressure to ensure patients improve quickly and are ready to discharge, he said.

“We felt that characterizing antibiotic prescriptions upon discharge from short-term medical units was an important first step in developing targeted stewardship interventions,” said Soper.

To this end, Soper and colleagues carried out a cross-sectional study on patients who were hospitalized in one of the two medical short-term units with a total of 40 beds. They included adults discharged with an oral antibiotic prescription between May 2018 and September 2019 and identified patients based on discharge diagnostic codes for common infections or abnormal urine cultures to identify urinary tract infections.

Of 100 patients discharged from short-term units on antibiotics, 47 had skin and soft tissue infections (SSTIs), 22 had pneumonia, 21 had urinary tract infections, and 10 other infections. According to the study, 78 cases (78%) were antibiotic overuse, including 39 (83%) among the 47 patients treated for SSTI, 17 (81%) among the 21 patients treated for urinary tract infections, and 14 (64%) ) among the 22 patients treated for pneumonia. In addition, 28 (28%) patients who were discharged had multiple types of antibiotic overuse.

The study showed that the most common forms of overuse were overtime (54%) with a median overtime of 3.5 days and guideline discordant selection (44%). Factors influencing overuse included recommendations from counselors, incorrect calculation of duration, and the need for a source control procedure, the researchers said.

“Short stay medical units are an overlooked source of significant antibiotic overuse and a dedicated management effort is required,” Soper said. “Such stewardship efforts will likely need to be tailored to the unique challenges of these units and will require collaboration with various advisory services.”

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