Valerie M. Vaughn, M.D., from the University of Michigan in Ann Arbor, and colleagues examined predictors and outcomes associated with excess duration of antibiotic treatment using retrospective data from 43 hospitals in the Michigan Hospital Medicine Safety Consortium (6,481 general care medical patients with pneumonia). Excess days were determined by subtracting each patient’s expected treatment duration (based on time to clinical stability, pathogen, and pneumonia classification) from the actual duration.
The researchers found that more than two-thirds of patients (67.8 percent) received excess antibiotic therapy, with most of the excess duration accounted for by antibiotics prescribed at discharge (93.2 percent). Excess treatment was more likely among patients who had respiratory cultures or nonculture diagnostic testing, had a longer stay, received a high-risk antibiotic in the previous 90 days, had community-acquired pneumonia, or did not have a total antibiotic treatment duration documented at discharge. Lower rates of adverse outcomes, including death, readmission, emergency department visit, or Clostridioides difficile infection, were not associated with excess treatment. However, there was a 5 percent increase in the odds of antibiotic-associated adverse events postdischarge with each excess day of treatment.
“Future interventions should focus on whether reducing excess treatment and improving documentation at discharge improves outcomes,” the authors write.
Several authors disclosed financial ties to Blue Cross Blue Shield of Michigan, which funded the study.
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Posted: July 2019