Cause of concern-Antibiotics being overused in UTI and pneumonia after discharge

The widespread use of antibiotics is estimated to have extended average life expectancy by two decades, shifting the paradigm from communicable to non-communicable diseases, but every time a new antimicrobial is introduced, drug resistance to that antimicrobial follows. There has been an exponential degree of rise in antimicrobial resistance globally. The decision to prescribe an antibiotic is complex and practitioners have given equivocal opinions regarding the same.

With such background, the present retrospective cohort study, led by researchers with Michigan Medicine, aimed to create a comprehensive metric to characterize antibiotic overuse after discharge among hospitalized patients treated for pneumonia or urinary tract infection (UTI) and determine whether overuse varied across hospitals and conditions.

The research team looked at patients treated for pneumonia or UTI at hospitals in the Michigan Hospital Medicine Safety Consortium from July 2017 through 2019 to quantify the proportion of patients discharged with antibiotic overuse, which was defined as unnecessary antibiotic use, excess antibiotic duration, or suboptimal fluoroquinolone use. The researchers used linear regression analysis to assess the hospital-level association between antibiotic overuse after discharge in patients treated for pneumonia versus patients treated for UTI.

On data analysis, the following key facts emerged.

· Of the 21,825 patients treated for infection (12,445 pneumonia, 9,380 UTI), 49.1% had antibiotic overuse after discharge, including 56.9% of patients treated for pneumonia, and 38.7% of patients treated for UTI.

· The median duration of antibiotic overuse after discharge was 4 days. In patients treated for pneumonia, 63.1% of overuse days after discharge were due to excess antibiotic duration, while in patients treated for UTI, 43.9% of overuse days were due to unnecessary antibiotic treatment of asymptomatic bacteriuria.

· The percentage of patients discharged with antibiotic overuse varied fivefold among hospitals, from 15.9% to 80.6%, and was strongly correlated between conditions.

· For every 10% increase in patients treated at a hospital for UTI who had overuse after discharge, there was an 8.5% increase in patients treated for pneumonia who had overuse after discharge.

The authors opined that antibiotic overuse after discharge was associated with conditions, like prescribing culture, physician behavior, or organizational processes contribute to overprescribing at discharge.

"Given the ubiquity of overuse after discharge, stewardship programs must enact interventions to improve prescribing—which often means stopping antibiotics—at care transitions," they wrote, adding that easier methods of tracking antibiotics at discharge could enable more complete national measures of antibiotic use.

Primary source: Clinical Infectious Diseases

For the full article click on the link: https://doi.org/10.1093/cid/ciaa1372