175 - Impact of Infectious Diseases Pharmacist Interventions on Appropriateness of Antibiotics Prescribed at Hospital Discharge

Background: Hospital discharge is an important opportunity for antimicrobial stewardship. Despite inpatient stewardship efforts, antibiotics ordered at discharge are frequently prescribed inappropriately. Discharge antibiotic therapy may be too broad or narrow in spectrum, inappropriately dosed, or for an unnecessarily long duration. The purpose of this study was to assess the inappropriateness of antimicrobial prescribing on discharge and to measure the effect of infectious diseases pharmacist (IDP) intervention on antibiotics prescribed at discharge from the inpatient setting.

Methods: Analyses were completed before and after implementation of an IDP intervention at hospital discharge. IDPs were alerted to patients discharged on antimicrobial therapy for community-acquired pneumonia (CAP), skin and soft tissue infections (SSTIs), and urinary tract infections (UTIs). IDPs reviewed patient and laboratory data and made recommendations for modifications of antibiotics prior to patients leaving the hospital. Prescribing algorithms were created and used to standardize the assessment of discharge antibiotics using local antibiograms and IDSA guidelines. The primary outcome was the composite of appropriateness including antibiotic dose, duration, and spectrum. Secondary outcomes included appropriateness of the individual components of the primary outcome as well as the mean total duration of antibiotic therapy per disease state.

Results: A total of 77 patients were assessed during the study period occurring December 2019 through February 2020. Intervention increased the rate of appropriate prescribing for the composite of antibiotic dose, duration, and spectrum from 48.1% at baseline to 84.4% (P < 0.05). By subset, intervention increased the proportion of patients receiving antibiotics of appropriate duration from 59.7% at baseline to 85.7% (P < 0.001), and proportion of patients receiving antibiotics of appropriate spectrum from 90.9% at baseline to 100% (P < 0.05). The mean duration of therapy for CAP decreased by 0.6 days (6.8 vs 7.4 days, P < 0.05).

Conclusion: IDP intervention improved appropriateness of prescribing consistent with guideline recommendations and local antibiogram data.