Rapid Clinical Updates: Antimicrobial Stewardship for Hospitalists-Slides

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This presentation on antimicrobial stewardship for hospitalists, led by Drs. Valerie Vaughn, Megan Mack, and moderated by Dr. Jagriti Chadha, emphasizes the critical role hospitalists play in combating antibiotic resistance and improving patient outcomes. Antibiotic overuse is identified as a major driver of resistance, with up to 50% of antibiotic prescriptions being unnecessary or suboptimal. Resistance leads to significant morbidity, mortality (over 1.2 million attributable deaths globally in 2019), adverse drug events (20% of hospitalized antibiotic recipients), and substantial healthcare costs.<br /><br />Stewardship challenges include competing clinical priorities, workflow interruptions, and time constraints heightened by clinician burnout, especially post-COVID. Despite these hurdles, there are high-yield stewardship opportunities that hospitalists can focus on.<br /><br />The first key opportunity involves avoiding treatment of asymptomatic bacteriuria (ASB)—the presence of bacteria in urine without symptoms of urinary tract infection (UTI). Many hospitalized patients, particularly elderly and those from nursing homes, exhibit ASB. Treating ASB does not improve outcomes and increases risks for antibiotic resistance and adverse events, including C. difficile infection. Importantly, altered mental status alone does not justify treatment for UTI unless accompanied by systemic signs such as fever or hemodynamic instability.<br /><br />The second stewardship moment focuses on antibiotic prescribing at hospital discharge. Studies found that 39-57% of patients discharged on antibiotics had overuse, including unnecessary antibiotics, excessive duration, or use of avoidable agents like fluoroquinolones. Hospitalists are urged to consider four questions at discharge: Can antibiotics be stopped? Is the narrowest, safest agent chosen? What is the shortest effective duration? Is there clear documentation including indication, dose, and duration?<br /><br />In summary, hospitalists should strive to reduce unnecessary antibiotic use by withholding treatment for ASB in the absence of infection, especially stable delirium, and by optimizing antibiotic regimens at discharge. These stewardship interventions can reduce resistance, improve patient safety, and contribute to more effective antibiotic use in acute care settings.

Keywords

antimicrobial stewardship

hospitalists

antibiotic resistance

antibiotic overuse

asymptomatic bacteriuria

urinary tract infection

antibiotic prescribing at discharge

clinician burnout

fluoroquinolones

patient safety