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      1816. Large-Scale Comparison of Antibiotic Prescription Guidelines Uncovers Disparities Among Stewardship Approaches

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      , BA, , PhD
      Open Forum Infectious Diseases
      Oxford University Press

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          Abstract

          Background

          The accrediting institution for hospitals in the United States made antimicrobial stewardship programs (ASPs) mandatory in 2017. In part due to the relatively new status of ASPs, standards surrounding the content produced by these programs are still in their infancy. One product of ASPs are antibiotic prescription guidelines, which vary greatly across hospitals in terms of their structure and content.

          Methods

          In this study, we reviewed 70 publicly available antibiotic prescription guidelines published from 2006 to 2017, originating from 12 countries on four continents to evaluate their coverage and variability.

          Results

          Guidelines varied greatly in terms of their length, word count, page layout, revision frequency, and number of contributing authors. In terms of content, guidelines were discordant in their inclusion of cost information, restricted antibiotics, disclaimers, and pediatric recommendations. Guidelines also varied in their approach, in that some were focused on how to approach specific diagnoses, while others were focused on the usage of particular antibiotics. Many guidelines made use of decision trees to convey information, especially for the diagnosis and treatment of Clostridium difficile-associated diarrhea, cellulitis, and community-acquired pneumonia; however, the number of decision trees included in a hospital’s guideline varied greatly. A small minority of guidelines included identification trees for classifying bacterial isolates. Guidelines also notably differed in the extent to which they incorporated local antibiotic susceptibility data. Some guidelines did not report antibiogram summaries, while others displayed information for 5 to 34 organisms. Furthermore, we assessed guidelines’ prescription recommendations for 12 common bacterial infections and found large variation in suggested prescribing practices across hospitals.

          Conclusion

          To our knowledge, this study provides the first large-scale analysis of antibiotic prescription guidelines and highlights the extreme variation in approaches to stewardship across hospitals. Furthermore, our analysis provides a baseline of current practices for future comparison, and initiates a discussion into what comprises a model antibiotic prescription guideline.

          Disclosures

          All authors: No reported disclosures.

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          Author and article information

          Journal
          Open Forum Infect Dis
          Open Forum Infect Dis
          ofid
          Open Forum Infectious Diseases
          Oxford University Press (US )
          2328-8957
          November 2018
          26 November 2018
          26 November 2018
          : 5
          : Suppl 1 , ID Week 2018 Abstracts
          : S515-S516
          Affiliations
          Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
          Article
          ofy210.1472
          10.1093/ofid/ofy210.1472
          6254023
          be8c742d-769c-484f-8cfd-c3e344b19344
          © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

          This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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          Pages: 2
          Categories
          Abstracts
          Poster Abstracts

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