By Valerie M. Vaughn, Scott A. Flanders, Ashley Snyder, Anna Conlon, Mary A.M. Rogers, Anurag N. Malani, Elizabeth McLaughlin, Sarah Bloemers, Arjun Srinivasan, Jerod Nagel, Scott Kaatz, Danielle Osterholzer, Rama Thyagarajan, Lama Hsaiky, Vineet Chopra, Tejal N. Gandhi
Annals of Internal Medicine, August 6, 2019
Randomized trials demonstrate no benefit from antibiotic treatment exceeding the shortest effective duration.The primary outcome was the rate of excess antibiotic treatment duration (excess days per 30-day period). Excess days were calculated by subtracting each patient's shortest effective (expected) treatment duration (based on time to clinical stability, pathogen, and pneumonia classification [community-acquired vs. health care–associated]) from the actual duration. Negative binomial generalized estimating equations (GEEs) were used to calculate rate ratios to assess predictors of 30-day rates of excess duration. Patient outcomes, assessed at 30 days via the medical record and telephone calls, were evaluated using logit GEEs that adjusted for patient characteristics and probability of treatment.
Two thirds (67.8% [4391 of 6481]) of patients received excess antibiotic therapy. Antibiotics prescribed at discharge accounted for 93.2% of excess duration. Patients who had respiratory cultures or nonculture diagnostic testing, had a longer stay, received a high-risk antibiotic in the prior 90 days, had community-acquired pneumonia, or did not have a total antibiotic treatment duration documented at discharge were more likely to receive excess treatment. Excess treatment was not associated with lower rates of any adverse outcomes, including death, readmission, emergency department visit, or Clostridioides difficile infection. Each excess day of treatment was associated with a 5% increase in the odds of antibiotic-associated adverse events reported by patients after discharge.