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Development of an Electronic Definition for De-escalation of Antibiotics in Hospitalized Patients.

Publication ,  Journal Article
Moehring, RW; Ashley, ESD; Davis, AE; Dyer, AP; Parish, A; Ren, X; Lokhnygina, Y; Hicks, LA; Srinivasan, A; Anderson, DJ
Published in: Clin Infect Dis
December 6, 2021

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 < .001). Diagnoses with lower de-escalation rates included intra-abdominal (23%) and skin and soft tissue (28%) infections. Critical care had higher rates of both de-escalation and escalation compared with wards. CONCLUSIONS: Our electronic de-escalation metric demonstrated variation among hospitals, units, and diagnoses. This metric may be useful for assessing stewardship opportunities and impact.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

December 6, 2021

Volume

73

Issue

11

Start / End Page

e4507 / e4514

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Microbiology
  • Humans
  • Electronics
  • Antimicrobial Stewardship
  • Anti-Bacterial Agents
  • Adult
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences
  • 06 Biological Sciences
 

Citation

APA
Chicago
ICMJE
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Moehring, R. W., Ashley, E. S. D., Davis, A. E., Dyer, A. P., Parish, A., Ren, X., … Anderson, D. J. (2021). Development of an Electronic Definition for De-escalation of Antibiotics in Hospitalized Patients. Clin Infect Dis, 73(11), e4507–e4514. https://doi.org/10.1093/cid/ciaa932
Moehring, Rebekah W., Elizabeth S Dodds Ashley, Angelina E. Davis, April Pridgen Dyer, Alice Parish, Xinru Ren, Yuliya Lokhnygina, Lauri A. Hicks, Arjun Srinivasan, and Deverick J. Anderson. “Development of an Electronic Definition for De-escalation of Antibiotics in Hospitalized Patients.Clin Infect Dis 73, no. 11 (December 6, 2021): e4507–14. https://doi.org/10.1093/cid/ciaa932.
Moehring RW, Ashley ESD, Davis AE, Dyer AP, Parish A, Ren X, et al. Development of an Electronic Definition for De-escalation of Antibiotics in Hospitalized Patients. Clin Infect Dis. 2021 Dec 6;73(11):e4507–14.
Moehring, Rebekah W., et al. “Development of an Electronic Definition for De-escalation of Antibiotics in Hospitalized Patients.Clin Infect Dis, vol. 73, no. 11, Dec. 2021, pp. e4507–14. Pubmed, doi:10.1093/cid/ciaa932.
Moehring RW, Ashley ESD, Davis AE, Dyer AP, Parish A, Ren X, Lokhnygina Y, Hicks LA, Srinivasan A, Anderson DJ. Development of an Electronic Definition for De-escalation of Antibiotics in Hospitalized Patients. Clin Infect Dis. 2021 Dec 6;73(11):e4507–e4514.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

December 6, 2021

Volume

73

Issue

11

Start / End Page

e4507 / e4514

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Microbiology
  • Humans
  • Electronics
  • Antimicrobial Stewardship
  • Anti-Bacterial Agents
  • Adult
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences
  • 06 Biological Sciences