Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Division of Health System Innovation and Research, Department of Population Health Science, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Clin Infect Dis. 2022 May 3;74(9):1696-1702. doi: 10.1093/cid/ciab842.
Though opportunities exist to improve antibiotic prescribing across the care spectrum, discharge from acute hospitalization is an increasingly recognized source of antibiotic overuse. Antimicrobials are prescribed to more than 1 in 8 patients at hospital discharge; approximately half of which could be improved. Key targets for antibiotic stewardship at discharge include unnecessary antibiotics, excess duration, avoidable fluoroquinolones, and improving (or avoiding) intravenous antibiotic therapy. Barriers to discharge antibiotic stewardship include the perceived "high stakes" of care transitions during which patients move from intense to infrequent observation, difficulties in antibiotic measurement to guide improvement at discharge, and poor communication across silos, particularly with skilled nursing facilities. In this review, we discuss what is currently known about antibiotic overuse at hospital discharge, key barriers, and targets for improving antibiotic prescribing at discharge and we introduce an evidence-based framework, the Reducing Overuse of Antibiotics at Discharge Home Framework, for conducting discharge antibiotic stewardship.
尽管有机会改善整个医疗保健领域的抗生素处方，但出院后仍存在抗生素过度使用的问题。在出院时，超过 1/8 的患者被开具了抗生素；其中约有一半可以改进。出院时抗生素管理的关键目标包括不必要的抗生素、过度使用抗生素、避免使用氟喹诺酮类药物，并改善（或避免）静脉用抗生素治疗。出院时抗生素管理的障碍包括在患者从密集观察过渡到不频繁观察的过程中，护理交接存在的“高风险”感知，以及在出院时指导抗生素改善方面的抗生素测量困难，以及各部门之间沟通不畅，特别是与熟练护理机构之间的沟通不畅。在这篇综述中，我们讨论了目前已知的出院时抗生素过度使用的情况、主要障碍以及改善出院时抗生素处方的目标，并介绍了一个基于证据的框架，即“减少出院时抗生素过度使用框架”，用于开展出院时抗生素管理。
