ADD it up: an evaluation of Antibiotic Duration at hospital Discharge at a community hospital
Abstract Purpose According to the CDC, patients admitted to the hospital are commonly discharged on antibiotic therapy with prolonged courses of therapy, which contributes to excessive antibiotic exposure and adverse events. The purpose of this study was to evaluate total antibiotic duration of therapy at hospital discharge at Indiana University (IU) Health Arnett, White Memorial, and Frankfort Hospitals. Methods A multicenter, retrospective electronic health record review was conducted from January 1, 2019, to June 30, 2019. Patients were included if they were at least 18 years of age, began antibiotic therapy while admitted, and continued antibiotic therapy at hospital discharge for one of the following indications: skin/soft tissue infection (SSTI), urinary tract infection (UTI), community-acquired pneumonia (CAP) or acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The days-of-therapy (DOT) of each inpatient and outpatient antibiotic prescribed were collected to calculate the total DOT, which was utilized to determine the appropriateness of the duration of therapy. Results Of the 547 patients included, 233 patients (42.6%) had CAP, 120 (21.9%) had UTI, 101 (18.5%) had SSTI, and 93 (17%) had AECOPD. The median duration of antibiotic therapy across all indications was 9 days (IQR 7-11). Median duration for CAP was 9 days (IQR 7-10), AECOPD was 7 days (IQR 5-9), UTI was 8 days (IQR 6-10), and SSTI was 12 days (IQR 10-14). Conclusions Excess antimicrobial duration at hospital discharge represents an unmet need of antimicrobial stewardship programs.