Evaluation of Multisite Programmatic Bundle to Reduce Unnecessary Antibiotic Prescribing for Respiratory Infections: A Retrospective Cohort Study

Dan Ilges; Kelsey Jensen; Evan Draper; Ross Dierkhising; Kimberly A Prigge; Paschalis Vergidis; Abinash Virk; Ryan W Stevens

doi:10.1093/ofid/ofad585

Evaluation of Multisite Programmatic Bundle to Reduce Unnecessary Antibiotic Prescribing for Respiratory Infections: A Retrospective Cohort Study

Open Forum Infect Dis. 2023 Nov 21;10(12):ofad585. doi: 10.1093/ofid/ofad585. eCollection 2023 Dec.

Authors

Dan Ilges¹, Kelsey Jensen², Evan Draper³, Ross Dierkhising⁴, Kimberly A Prigge⁵, Paschalis Vergidis⁶, Abinash Virk⁶, Ryan W Stevens²

Affiliations

¹ Department of Pharmacy Services, Mayo Clinic Arizona, Phoenix, Arizona, USA.
² Department of Pharmacy Services, Mayo Clinic Health System-Southeast Minnesota, Austin, Minnesota, USA.
³ Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, USA.
⁴ Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Division of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Abstract

Background: The aim of this study was to evaluate the frequency of unnecessary antibiotic prescribing for Tier 3 upper respiratory infection (URI) syndromes across the Mayo Clinic Enterprise before and after a multifaceted antimicrobial stewardship intervention, and to determine ongoing factors associated with antibiotic prescribing and repeat respiratory healthcare contact in the postintervention period.

Methods: This was a quasi-experimental, pre/post, retrospective cohort study from 1 January 2019 through 31 December 2022, with 12-month washout during implementation from 1 July 2020 through 30 June 2021. All outpatient encounters, adult and pediatric, from primary care, urgent care, and emergency medicine specialties with a Tier 3 URI diagnosis were included. The intervention was a multifaceted outpatient antibiotic stewardship bundle. The primary outcome was the rate of antibiotic prescribing in Tier 3 encounters. Secondary outcomes included 14-day repeat healthcare contact for respiratory indications and factors associated with persistent unnecessary prescribing.

Results: A total of 165 658 Tier 3 encounters, 96 125 in the preintervention and 69 533 in the postintervention period, were included. Following intervention, the prescribing rate for Tier 3 encounters decreased from 21.7% to 11.2% (P < .001). Repeat 14-day respiratory healthcare contact in the no antibiotic group was lower postintervention (9.9.% vs 9.4%; P = .004). Multivariable models indicated that increasing patient age, Charlson comorbidity index, and primary diagnosis selected were the most important factors associated with persistent unnecessary antibiotic prescribing.

Conclusions: Outpatient antibiotic stewardship initiatives can reduce unnecessary antibiotic prescribing for Tier 3 URIs without increasing repeat respiratory healthcare contact. Advancing age and number of comorbidities remain risk factors for persistent unnecessary antibiotic prescribing.