Category: Antimicrobial Stewardship: Outcomes Assessment (clinical and economic)

Poster Session: Antimicrobial Stewardship: Outcomes Assessment (clinical and economic)

63 - Frequency and Outcomes of Patients Prescribed Antibiotics for Extended Durations on Discharge from the Hospital to Nursing Homes

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Co-Author(s)

KM

Kaitlyn E. Molina

PharmD Candidate
Oregon State University
Portland, Oregon
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BN

Brie N. Noble

Senior Faculty Research Analyst
Oregon State University
Portland, OR
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Christopher J. Crnich

Associate Professor of Medicine
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Jessina C. McGregor

Professor
Oregon State University
Portland, OR
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DB

David T. Bearden

Clinical Professor
Oregon State University/Oregon Health & Sciences University
Portland, OR
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DC

Dominic Chan

Clinical Coordinator - Antimicrobial Stewardship & Infectious Diseases
Legacy Health
Portland, OR
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Presenting Author(s)

Jon P. Furuno

Interim Department Chair
Oregon State University
Portland, Oregon
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Nursing home (NH) residents are at increased risk of being prescribed antibiotic for extended durations and experiencing antibiotic-associated adverse events. However, many of these antibiotics are prescribed in the hospital prior to NH admission. We quantified the frequency, characteristics and outcomes of patients receiving antibiotic treatment in the hospital and discharged to NHs with an antibiotic prescription for greater than 7 days.

Methods: This was a retrospective cohort study of adult (age >18 years) patients with a prescription for an antibiotic on discharge from Oregon Health & Science University Hospital (OHSU) to a NH between January 1, 2016 and December 31, 2018. Study data were collected from an electronic repository of patients’ electronic health record data. Outcomes of interest included having an emergency department (ED) visit, inpatient hospital admission, or inpatient admission for Clostridioides difficile infection (CDI) at the index facility within 30 days of discharge.

Results: Among 2969 antibiotic prescriptions on discharge, 1267 (42.7%) were prescribed for greater than 7 days to a total of 1059 patients. A diagnosis of a bacterial infection was present for 902 (85.2%) patients. The most frequent diagnoses were bloodstream/endocarditis (21.8%), osteomyelitis (11.6%), and skin and soft tissue infections (10.6%). The most frequently prescribed antibiotics were cephalosporins (24.2%), penicillins (14.1%), glycopeptides (12.9%), and fluoroquinolones (12.6%). Of the 1059 identified patients, 126 (11.9%) had an ED visit, 216 (20.4%) inpatient admission, and 16 (1.5%) had an admission for CDI within 30 days of discharge.

Conclusion: More than 40% of antibiotic prescriptions on discharge to a NH were for greater than 7 days. This frequency and associated poor outcomes suggest extended antibiotic duration are a high-value target to improve antibiotic prescribing on discharge to NHs.