Category: Antimicrobial Stewardship: Program Development and Implementation

Poster Session: Antimicrobial Stewardship: Program Development and Implementation

154 - Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Adults with Acute Pharyngitis

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Presenting Author(s)

Ebbing Lautenbach

Professor of Medicine and Epidemiology
University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Keith W. Hamilton

Professor of Clinical Medicine
University of Pennsylvania Perelman School of Medicine
Philadelphia, PA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RG

Robert Grundmeier

Associate Professor
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MN

Melinda M. Neuhauser

Pharmacist and Acute Care Lead
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention,
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Lauri A. Hicks

Director, Office of Antibiotic Stewardship
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AJ

Anne Jaskowiak

Project Manager
University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LC

Leigh Cressman

Senior Data Analyst
University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TJ

Tony James

Research Assistant
University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JO

Jacqueline Omorogbe

Research Coordinator
University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
NF

Nicole Frager

Project Manager
University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MM

Muida Menon

Research Coordinator
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EK

Ellen Kratz

Project Manager
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Jeffrey Gerber

Associate Professor of Pediatrics
Children's Hospital of Philadelphia
Philadelphia, PA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Although most antibiotic use occurs in outpatients, antibiotic stewardship programs (ASPs) have primarily focused on inpatients. A major challenge for outpatient ASPs is lack of accurate and accessible electronic data to target interventions. We developed and validated an electronic algorithm to identify inappropriate antibiotic use for adult outpatients with acute pharyngitis.

Methods: In the University of Pennsylvania Health System, we used ICD-10 diagnostic codes to identify patient encounters for acute pharyngitis at outpatient practices between 3/15/17 – 3/14/18. Exclusion criteria included immunocompromising conditions, comorbidities, and concurrent infections that might require antibiotic use. We randomly selected 300 eligible subjects. Inappropriate antibiotic use based on chart review served as the basis for assessment of the electronic algorithm which was constructed using only data in the electronic health record (EHR). Criteria for appropriate prescribing, choice of antibiotic, and duration included positive streptococcal testing, use of penicillin/amoxicillin (absent b-lactam allergy), and 10 days maximum duration of therapy.

Results: Of 300 subjects, median age was 42, 75% were female, 64% were seen by internal medicine (vs. family medicine), and 69% were seen by a physician (vs. advanced practice provider). On chart review, 127 (42%) subjects received an antibiotic, of which 29 had a positive streptococcal test and 4 had another appropriate indication. Thus, 74% (94/127) of patients received antibiotics inappropriately. Of the 29 patients who received appropriate prescribing, 27 (93%) received an appropriate antibiotic. Finally, of the 29 patients who were appropriately treated, 29 (100%) received the correct duration. Test characteristics of the EHR algorithm (compared to chart review) are noted in the Table.

Conclusion: Inappropriate antibiotic prescribing for acute pharyngitis is common. An electronic algorithm for identifying inappropriate prescribing, antibiotic choice, and duration is highly accurate. This algorithm could be used to efficiently assess prescribing among practices and individual clinicians. The impact of interventions based on this algorithm should be tested in future work.Test Characteristics of Electronic Algorithm for Inappropriate Prescribing, Agent, and Duration