More than 50% of antibiotics prescribed to patients hospitalized for community-acquired pneumonia or urinary tract infection were not consistent with recommended prescribing practices, according to findings from a cross-sectional study published in JAMA Open Network

Antibiotic prescribing patterns vary widely among hospitals. This study, which was based on data from a survey of medical records conducted by the Centers for Disease Control and Prevention’s Emerging Infections Program, was designed to assess the percentage of hospital antibiotic use that deviated from recommendation practice in terms of treatment selection, duration of use, and medical record documentation.

Shelley S. Magill, MD, PhD, and colleagues analyzed data from 1566 patients (median age, 67 years; 55.2% women) hospitalized at 1 of 192 hospitals in 10 states between May 1 and September 30, 2015. These patients had at least 1 of the following infection-based events or antimicrobial-based events:

  • Treatment of community-acquired pneumonia (CAP)
  • Treatment of urinary tract infection (UTI) present at admission
  • Treatment with fluoroquinolones
  • Treatment with intravenous (IV) vancomycin

Appropriateness of prescribing was evaluated using the antimicrobial quality assessment analysis pathway developed by CDC staff.


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Key Findings

Prescribing deviated from recommended practice for 55.9% of patients with these 4 select events. Antibiotic prescribing was not supported for 79.5% and 76.8% of patients with CAP and UTI, respectively. Additionally, antibiotic prescribing was not supported for 46.5% and 27.3% of patients prescribed fluoroquinolones or IV vancomycin, respectively.

Common reasons for unsupported treatment included excessive treatment duration (59.2% in patients with CAP) and lack of documented infection signs and symptoms (50.1% in patients with UTI). Other reasons included antibiotic selection that deviated from clinical guidelines and lack of supporting microbial data confirming the presence of an infection.

Study limitations include the limited number of states with hospitals included in the study, the limited prescribing events evaluated, and exclusion of antibiotic prescribing for surgical or medical prophylaxis. Additionally, the assessment was based on medical record documentation and incomplete documentation may affect the results.

“The findings suggest that standardized assessments of hospital antimicrobial prescribing quality can be used to estimate the appropriateness of antimicrobial use in large groups of hospitals,” Dr Magill and colleagues concluded.

Disclosures: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.

Reference

Magill SS, O’Leary E, Ray SM, et al. Assessment of the appropriateness of antimicrobial use in US hospitals. JAMA Netw Open. 2021;4(3):e212007. doi: 10.1001/jamanetworkopen.2021.2007