Decreased Overall and Inappropriate Antibiotic Prescribing in a Veterans Affairs Emergency Department Following A Peer-Comparison-Based Stewardship Intervention.
Antimicrob Agents Chemother. 2020 Oct 05;:
Authors: Buehrle DJ, Phulputo RH, Wagener MM, Clancy CJ, Decker BK
Background: Antibiotic prescribing is very common in emergency departments (EDs). Optimal stewardship intervention strategies in EDs are not well defined.Methods: We conducted a prospective, observational cohort study in a Veterans Affairs ED, in which clinician education and monthly e-mail-based peer comparisons were directed against all oral antibiotic prescribing for discharged patients. Oral antibiotic prescriptions were compared in baseline (June 2016-December 2017) and intervention (January-June 2018) periods using an interrupted time series regression model. Prescribing appropriateness was compared during January-June 2017 and the intervention period.Results: During the intervention period, antibiotic prescriptions decreased monthly by 10.4 prescriptions per 1,000 ED visits (P=0.07, [95% CI, -21.7 to 1.0]). The relative decrease in the trend of antibiotic prescriptions during the intervention period compared to baseline was 9.9 prescriptions per 1,000 ED visits per month (P=0.07, [95% CI, -20.9 to 1.0]). The intervention was associated with a significant decrease and increase in amoxicillin-clavulanate and cephalexin prescriptions, respectively (P<0.001, P=0.004). Decreasing trends in ciprofloxacin prescriptions during the baseline period were maintained during the intervention. Unnecessary antibiotic prescribing (i.e., antibiotic not indicated) decreased from 55.6% to 38.7% during the intervention (30.4% decrease, P=0.003). Optimal antibiotic prescribing (i.e., antibiotics were indicated, and a guideline-concordant agent was prescribed for guideline-concordant duration) increased by 36% (21.6% to 29.3%, P=0.12).Conclusions: A peer-comparison based stewardship intervention directed at ED clinicians was associated with reductions in overall and unnecessary oral antibiotic prescribing. There is potential to further improve antibiotic use as suboptimal prescribing remained common.
PMID: 33020159 [PubMed - as supplied by publisher]