Rapid Clinical Updates: Antimicrobial Stewardship for Hospitalists-Handout

Handout

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The document highlights the critical issue of antibiotic use and its consequences in healthcare. Over 20% of patients receiving antibiotics experience adverse drug events, and treating multi-drug resistant infections costs the U.S. healthcare system approximately $2.2 billion annually. This has prompted the 2023 Joint Commission to emphasize stewardship in diagnostics and antibiotic use to improve patient outcomes and reduce societal costs.<br /><br />A key focus is on asymptomatic bacteriuria, especially prevalent among the elderly. Clinical guidelines recommend withholding antibiotics in the absence of urinary symptoms or systemic infection signs, even if patients exhibit confusion. Treating asymptomatic bacteriuria unnecessarily increases costs and hospital stays without improving outcomes. Patients with altered mental status and positive urinalysis but no urinary symptoms can be safely observed without antibiotics for 48 hours, making routine urine testing in such cases potentially wasteful.<br /><br />Another concern is the overprescribing of antibiotics at hospital discharge. For example, around 40% of heart failure patients receive antibiotics unnecessarily, which raises fluid and sodium retention, prolongs hospital stays, and increases readmission rates. Each excess day of antibiotic treatment for pneumonia is associated with a 5% higher risk of antibiotic-related adverse events. Strategies to reduce overuse include counting inpatient treatment days and adopting the shortest effective antibiotic duration for responding patients.<br /><br />Overall, the document calls for improved antibiotic stewardship by following evidence-based guidelines, minimizing unnecessary diagnostic testing and antibiotic use, and tailoring treatment duration to reduce adverse events, costs, and the emergence of drug resistance.

Keywords

antibiotic stewardship

adverse drug events

multi-drug resistant infections

asymptomatic bacteriuria

clinical guidelines

overprescribing antibiotics

hospital discharge

heart failure patients

antibiotic duration

diagnostic testing