Development of an Electronic Definition for De-escalation of Antibiotics in Hospitalized Patients
| Autor: | Angelina Davis, Arjun Srinivasan, Lauri A. Hicks, Xinru Ren, Yuliya Lokhnygina, Elizabeth Dodds Ashley, Alice Parish, Deverick J. Anderson, Rebekah W. Moehring, April Dyer |
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| Rok vydání: | 2020 |
| Předmět: |
Microbiology (medical)
Adult medicine.medical_specialty medicine.drug_class Hospitalized patients Antibiotics 030501 epidemiology Narrow spectrum 03 medical and health sciences Antimicrobial Stewardship 0302 clinical medicine Internal medicine Antibiotic therapy medicine Antimicrobial stewardship Humans 030212 general & internal medicine Retrospective Studies business.industry Retrospective cohort study Anti-Bacterial Agents Infectious Diseases Electronic data Electronics 0305 other medical science business De-escalation |
| Zdroj: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 73(11) |
| ISSN: | 1537-6591 |
| Popis: | Background Antimicrobial stewardship programs (ASPs) promote the principle of de-escalation: moving from broad- to narrow-spectrum agents and stopping antibiotics when no longer indicated. A standard, objective definition of de-escalation applied to electronic data could be useful for ASP assessments. Methods We derived an electronic definition of antibiotic de-escalation and performed a retrospective study among 5 hospitals. Antibiotics were ranked into 4 categories: narrow-spectrum, broad-spectrum, extended-spectrum, and agents targeted for protection. Eligible adult patients were cared for on inpatient units, had antibiotic therapy for at least 2 days, and were hospitalized for at least 3 days after starting antibiotics. Number of antibiotics and rank were assessed at 2 time points: day of antibiotic initiation and either day of discharge or day 5. De-escalation was defined as reduction in either the number of antibiotics or rank. Escalation was an increase in either number or rank. Unchanged was either no change or discordant directions of change. We summarized outcomes among hospitals, units, and diagnoses. Results Among 39 226 eligible admissions, de-escalation occurred in 14 138 (36%), escalation in 5129 (13%), and antibiotics were unchanged in 19 959 (51%). De-escalation varied among hospitals (median, 37%; range, 31–39%, P Conclusions Our electronic de-escalation metric demonstrated variation among hospitals, units, and diagnoses. This metric may be useful for assessing stewardship opportunities and impact. |
| Databáze: | OpenAIRE |
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