Russell J Benefield, Chanah K Becker, Julie Gray, Heather Cummins, Laura K Certain
{"title":"（Re）移动针头：对骨科感染口服抗生素处方治疗指南影响的回顾性、准实验性评估。","authors":"Russell J Benefield, Chanah K Becker, Julie Gray, Heather Cummins, Laura K Certain","doi":"10.1017/ash.2025.52","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Despite many reports of similar effectiveness between oral and intravenous antibiotics for bone and joint infections, prescribing practice has been slow to change in the United States. We sought to determine if implementing an intravenous-to-oral treatment guideline could increase prescribing of oral antibiotic regimens at our center.</p><p><strong>Design: </strong>Retrospective, quasi-experimental study.</p><p><strong>Setting: </strong>Single US academic medical center.</p><p><strong>Patients: </strong>Patients with bone or joint infections managed by Infectious Disease providers from September 2020 to December 2022.</p><p><strong>Intervention: </strong>An intravenous-to-oral treatment guideline for patients with bone and joint infections.</p><p><strong>Methods: </strong>The prescribing rates of fully oral antibiotic regimens before and after implementation of the guideline were compared. Additionally, variables independently associated with oral antibiotic prescribing were identified by logistic regression.</p><p><strong>Results: </strong>There were 450 patients included: 213 before and 237 after implementation of the guideline. Oral antibiotic prescribing significantly increased following implementation of the treatment guideline to 59% from 33% of patients (difference 25.8%, 95% CI [16.7%, 34.4%]. In multivariable analysis, the post-intervention phase was associated with a significantly greater likelihood of oral antibiotic prescribing (aOR 2.89 [1.90, 4.45]). Other variables independently associated with oral antibiotic prescribing included male sex (aOR 1.88 [1.20, 2.98]), prosthetic joint infection (aOR 0.29 [0.17, 0.47]), and infection with <i>Enterobacterales</i> (aOR 2.86 [1.45, 5.92]), methicillin-sensitive <i>Staphylococcus aureus</i> [aOR 0.41 [0.26, 0.65]), or coagulase-negative staphylococci (aOR 0.34 [0.18, 0.62]).</p><p><strong>Conclusions: </strong>Implementation of a treatment guideline resulted in a significant increase in oral antibiotic prescribing. Antimicrobial stewardship programs should implement similar interventions to improve outpatient antibiotic utilization.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e84"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951238/pdf/","citationCount":"0","resultStr":"{\"title\":\"(Re)Moving the needle: a retrospective, quasi-experimental assessment of the impact of a treatment guideline on oral antibiotic prescribing for orthopedic infections.\",\"authors\":\"Russell J Benefield, Chanah K Becker, Julie Gray, Heather Cummins, Laura K Certain\",\"doi\":\"10.1017/ash.2025.52\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Despite many reports of similar effectiveness between oral and intravenous antibiotics for bone and joint infections, prescribing practice has been slow to change in the United States. We sought to determine if implementing an intravenous-to-oral treatment guideline could increase prescribing of oral antibiotic regimens at our center.</p><p><strong>Design: </strong>Retrospective, quasi-experimental study.</p><p><strong>Setting: </strong>Single US academic medical center.</p><p><strong>Patients: </strong>Patients with bone or joint infections managed by Infectious Disease providers from September 2020 to December 2022.</p><p><strong>Intervention: </strong>An intravenous-to-oral treatment guideline for patients with bone and joint infections.</p><p><strong>Methods: </strong>The prescribing rates of fully oral antibiotic regimens before and after implementation of the guideline were compared. Additionally, variables independently associated with oral antibiotic prescribing were identified by logistic regression.</p><p><strong>Results: </strong>There were 450 patients included: 213 before and 237 after implementation of the guideline. Oral antibiotic prescribing significantly increased following implementation of the treatment guideline to 59% from 33% of patients (difference 25.8%, 95% CI [16.7%, 34.4%]. In multivariable analysis, the post-intervention phase was associated with a significantly greater likelihood of oral antibiotic prescribing (aOR 2.89 [1.90, 4.45]). Other variables independently associated with oral antibiotic prescribing included male sex (aOR 1.88 [1.20, 2.98]), prosthetic joint infection (aOR 0.29 [0.17, 0.47]), and infection with <i>Enterobacterales</i> (aOR 2.86 [1.45, 5.92]), methicillin-sensitive <i>Staphylococcus aureus</i> [aOR 0.41 [0.26, 0.65]), or coagulase-negative staphylococci (aOR 0.34 [0.18, 0.62]).</p><p><strong>Conclusions: </strong>Implementation of a treatment guideline resulted in a significant increase in oral antibiotic prescribing. Antimicrobial stewardship programs should implement similar interventions to improve outpatient antibiotic utilization.</p>\",\"PeriodicalId\":72246,\"journal\":{\"name\":\"Antimicrobial stewardship & healthcare epidemiology : ASHE\",\"volume\":\"5 1\",\"pages\":\"e84\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-03-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951238/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Antimicrobial stewardship & healthcare epidemiology : ASHE\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1017/ash.2025.52\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Antimicrobial stewardship & healthcare epidemiology : ASHE","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1017/ash.2025.52","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
(Re)Moving the needle: a retrospective, quasi-experimental assessment of the impact of a treatment guideline on oral antibiotic prescribing for orthopedic infections.
Objective: Despite many reports of similar effectiveness between oral and intravenous antibiotics for bone and joint infections, prescribing practice has been slow to change in the United States. We sought to determine if implementing an intravenous-to-oral treatment guideline could increase prescribing of oral antibiotic regimens at our center.
Design: Retrospective, quasi-experimental study.
Setting: Single US academic medical center.
Patients: Patients with bone or joint infections managed by Infectious Disease providers from September 2020 to December 2022.
Intervention: An intravenous-to-oral treatment guideline for patients with bone and joint infections.
Methods: The prescribing rates of fully oral antibiotic regimens before and after implementation of the guideline were compared. Additionally, variables independently associated with oral antibiotic prescribing were identified by logistic regression.
Results: There were 450 patients included: 213 before and 237 after implementation of the guideline. Oral antibiotic prescribing significantly increased following implementation of the treatment guideline to 59% from 33% of patients (difference 25.8%, 95% CI [16.7%, 34.4%]. In multivariable analysis, the post-intervention phase was associated with a significantly greater likelihood of oral antibiotic prescribing (aOR 2.89 [1.90, 4.45]). Other variables independently associated with oral antibiotic prescribing included male sex (aOR 1.88 [1.20, 2.98]), prosthetic joint infection (aOR 0.29 [0.17, 0.47]), and infection with Enterobacterales (aOR 2.86 [1.45, 5.92]), methicillin-sensitive Staphylococcus aureus [aOR 0.41 [0.26, 0.65]), or coagulase-negative staphylococci (aOR 0.34 [0.18, 0.62]).
Conclusions: Implementation of a treatment guideline resulted in a significant increase in oral antibiotic prescribing. Antimicrobial stewardship programs should implement similar interventions to improve outpatient antibiotic utilization.
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