Background
Provider-entered indications for antibiotics have been recommended as a tracking tool
for antibiotic stewardship programs. The accuracy and utility of these indications
are unknown.
Methods
Drug-specific lists of evidence-based indications were integrated into an electronic
health system as an ordering hard-stop. We reviewed antibiotic orders with provider-entered
indications to determine whether the chosen indication matched the documentation and
whether antibiotic use was appropriate.
Results
One hundred fifty-five antibiotic orders were reviewed. Clinical documentation supported
the entered indication in 80% of vancomycin orders, 78% of cefepime orders, and 74%
of fluoroquinolone orders. The clinical appropriateness for vancomycin, cefepime,
and fluoroquinolones were 94%, 100%, and 68%, respectively. When providers chose indications
from the list as opposed to choosing “other” and entering free text, antibiotic orders
were significantly more likely to be appropriate (odds ratio, 5.8; P = .001) but also less likely to match clinical documentation (odds ratio, 0.25; P = .0043).
Discussion
Provider-chosen indications are, overall, an accurate reflection of the true reason
for antibiotic use at our institution. Providers frequently documented reasons for
fluoroquinolone use that were not among the provided indications.
Conclusion
Selecting an indication from an evidence-based list as opposed to free-text indications
increases the odds that antibiotic agents will be used appropriately.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Infection ControlAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Antimicrobial stewardship programs in health care systems.Clin Microbiol Rev. 2005; 18: 638-656
- Antimicrobial stewardship.Am J Infect Control. 2006; 34: S55-S63
- Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Diseases Society (PIDS).Infect Control Hosp Epidemiol. 2012; 33: 322-327
- Approved: new antimicrobial stewardship standard.Jt Comm Perspect. 2016; 36: 1-8
- Measuring appropriate antimicrobial use: attempts at opening the black box.Clin Infect Dis. 2016; 63: 1639-1644
- Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians.JAMA. 2013; 309: 2345-2352
- Impact of antimicrobial stewardship in critical care: a systematic review.J Antimicrob Chemother. 2011; 66: 1223-1230
- Impact of an antimicrobial stewardship intervention on shortening the duration of therapy for community-acquired pneumonia.Clin Inf Dis. 2012; 54: 1581-1587
Johns Hopkins Medicine. Antibiotic guidelines 2015-2016.
- Clinical indications for antibiotic use in Danish general practice: results from a nationwide electronic prescription database.Scand J Prim Health Care. 2017; 35: 162-169
- Impact of a web-based antimicrobial approval system on broad-spectrum cephalosporin use at a teaching hospital.Med J Aust. 2003; 178: 386-390
- A pseudo-outbreak of nosocomial infections associated with the introduction of an antibiotic management programme.J Hosp Infect. 2003; 55: 26-32
Article info
Publication history
Published online: May 31, 2018
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
