Mayo Clinic’s multifaceted outpatient antibiotic stewardship intervention lowered unnecessary antibiotic prescribing for upper respiratory infections, according to a new study. The report was published on Nov. 21 in Open Forum Infectious Diseases.
The intervention was launched at Mayo Clinic facilities in Minnesota, Wisconsin, Florida and Arizona in July 2020. The goal was to reduce antibiotics used for Tier 3 upper respiratory infection syndromes, which are infections that don’t require antibiotics.
A few interventions used included educating providers; creating a syndrome-based, pre-populated ambulatory panel; reporting on peer comparisons; and making a provider data interface to flag cases where antibiotics were deemed unnecessary. An antibiotic commitment poster and handouts for patients promoting symptomatic management were also included.
The analysis included 165,658 Tier 3 encounters — 96,125 before the intervention launched, and 69,533 after it started. About 45% of encounters with patients were in those aged 18 and under.
After the intervention, the prescribing rate for Tier 3 encounters fell from 21.7% to 11.2% overall (a 48.4% relative reduction), equaling about 7,300 unnecessary antibiotic prescriptions avoided. In urgent care, the intervention produced a 51.8% relative reduction in prescribing — the largest improvement. Significant reductions were observed in all geographic regions and departments as a result of the intervention.
Repeat 14-day respiratory healthcare contact was less common when an antibiotic was prescribed in the overall group. It was lower in people who didn’t take antibiotics after the intervention. Increasing patient age, Charlson comorbidity index and primary diagnosis selected were the most important factors linked to persistent unnecessary antibiotic prescribing.
“Outpatient antibiotic stewardship initiatives can reduce unnecessary antibiotic prescribing for Tier 3 upper respiratory infections without increasing repeat respiratory healthcare contact. Advancing age and number of comorbidities remain risk factors for persistent unnecessary antibiotic prescribing,” the authors wrote.
