Improving antibiotic use for sinusitis and upper respiratory tract infections: A virtual-visit antibiotic stewardship initiative. (31st December 2022)

• Record Type: Journal Article
• Authors: Wasylyshyn, Anastasia I.; Kaye, Keith S.; Chen, Julia; Haddad, Haley; Nagel, Jerod; Petrie, Joshua G.; Gandhi, Tejal N.; Petty, Lindsay A.
• Is Part Of: Infection control and hospital epidemiology. Volume 43:Number 12(2022)
• Page Start: 1890
• Page End: 1893
• Publication Date: 2022-12-31
• Subjects: Nosocomial infections -- Epidemiology -- Periodicals; Health facilities -- Sanitation -- Periodicals; Hospital buildings -- Sanitation -- Periodicals; Cross Infection -- Periodicals; Epidemiology -- Periodicals; Hospitals -- Periodicals; Infection Control -- Periodicals; 614.44
• DOI: 10.1017/ice.2022.19
• Languages: English
• ISSNs: 0899-823X

Abstract

Abstract: Background: Asynchronous virtual patient care is increasingly used; however, the effectiveness of virtually delivering guideline-concordant care in conjunction with antibiotic stewardship initiatives remains uncertain. We developed a bundled stewardship intervention to improve antibiotic use in E-visits for upper respiratory tract infections (URTIs). Methods: In this before-and-after study, adult patients who completed E-visits for "cough, " "flu, " or "sinus symptoms" at Michigan Medicine between January 1, 2018, and September 30, 2020, were included. Patient demographics, diagnoses, and antibiotic details were collected. The multifaceted intervention occurred over 6 months. Segmented linear regression was performed to estimate the effect of the intervention on appropriate antibiotic use for URTI diagnoses (defined as no antibiotic prescribed) and sinusitis (defined as guideline-concordant antibiotic selection and duration). Regression lines were fit to data before the bundled intervention (January 2019) and after the bundled intervention (May 2019). Results: In total, 5, 151 E-visits were included. The intervention decreased the number of visits for flu, cough, or sinus symptoms prescribed antibiotics from 43.2% to 28.9% ( P < .001). Guideline concordance of antibiotic prescriptions improved following the intervention: first-line amoxicillin-clavulanate rose from 37.9% of prescriptions to 66.1% of prescriptions ( P < .001), second-line doxycycline rose from 13.8% to 22.7% ( P < .001); and median duration of antibiotics decreased from 10 days to 5 days ( P < .001). Conclusions: A multifaceted stewardship bundle for E-visits involving both changes in the EMR and audit and feedback improved guideline-concordant antibiotic use for URTIs. This approach can aid stewardship efforts in the ambulatory care setting with regard to telemedicine.