Safety of Stopping Antibiotics Prescribed “Just in Case” – Comparison of Mortality, Readmissions and Clostridium difficile in Patients with Accepted Stewardship Interventions Compared with Declined

Abstract

Background. Antibiotics are ofen prescribed "just in case" when clinical conditions mimic an infection, such as the shortness of breath in heart failure, the erythema of venous stasis or when bacterial culture results are misleading such as asymptomatic bacteriuria (ABU) and C difcile colonization. Trough prospective audit and feedback (PAF), antimicrobial stewardship programs (ASP) may guide providers toward appropriate antibiotic use. However, the safety of stopping antibiotics needs to be assessed. We retrospectively reviewed the clinical outcomes of patients with accepted ASP recommendations and compared these to patients in whom the primary team declined ASP recommendations. Methods. The ASP database was used to identify patients receiving written PAF to stop antibiotics prescribed for noninfectious conditions from January 1, 2016 to December 31, 2016. The primary objective was to compare antibiotic days of therapy (DOT), total length of therapy (LOT), hospital length of stay (LOS), 30-day mortality, and the incidence of C. difcile within 6 months of the ASP intervention, occurring among patients whose primary treating team accepted vs. rejected the ASP recommendation. We compared the two groups using Chi-square and student t-test to determine statistical signifcance for categorical and continuous variables, respectively. Results. There were 232 ASP recommendations to stop antibiotics for nonin-fectious conditions:150 (65%) interventions were accepted. Baseline demographic characteristics, comorbidities, intensive care admission and surgery during that hospi-talization were similar between the two groups. The most common noninfectious conditions were ABU (55%), followed by respiratory (19%) and intra-abdominal (17%). The median antibiotic DOT and LOT were significantly reduced in the accepted group, 3 (3-5) vs. 8 (5-12.25) days (P < 0.001) and 3 (2-4) vs. 7 (5-10) days (P < 0.001), respectively. There were no statistical Differences in 30-day mortality, 30-day readmis-sion, and C.difcilewithin 6 months. Conclusion. Our institutional ASP's PAF to stop antibiotics for noninfectious conditions led to a significant reduction in antimicrobial exposure without negatively afecting mortality or hospital outcomes.