2026 Southeastern Residency Conference

Evaluating Antibiotic Overuse at Hospital Discharge for Uncomplicated Community Acquired Pneumonia and Urinary Tract Infections: A Retrospective Review
 
Blake McClellan, Sarah Grace Gunter, Noah Sanford, Braxton Clines, Elizabeth Covington

Abstract
Purpose: Inappropriate antibiotic prescribing at the time of hospital discharge represents a significant challenge to antimicrobial stewardship. Antibiotic overprescribing can carry serious consequences, such as antimicrobial resistance, adverse drug events, and increased healthcare costs. Studies have found high percentages of patients discharged with antibiotic durations exceeding guideline duration for urinary tract infections and community acquired pneumonia. This project evaluated discharge antibiotic prescribing at a community hospital located in the southeastern United States.

Methods: This retrospective chart review was approved by the Institutional Review Boards at East Alabama Medical Center (EAMC) and Auburn University. Study participants were screened from a pre-existing dataset of patients with infectious disease tests resulting post-discharge from August 2022 through October 2024. Inclusion criteria were as follows: findings consistent with uncomplicated urinary tract infection or community acquired pneumonia, discharged alive, and inpatient encounter with microbiology testing performed at EAMC. Exclusion criteria included patients with blood or urine culture contamination, Candida sp. growth in sputum, Pseudomonas sp. growth in stool, vaginal Group B Streptococcal swabs, no inpatient encounter, transfer to another facility at discharge, death prior to culture result, or classification as vulnerable population (<18 years or incarceration). The primary endpoint was percentage of patients with antibiotic overuse post-discharge based on the Vaughn et al. definition: unnecessary antibiotic use, excess duration of antibiotic use, and/or suboptimal use of fluoroquinolone therapy. Secondary endpoints included individual components of the antibiotic overuse definition, median days of antibiotic overuse after discharge, total antibiotic duration, duration of inpatient versus outpatient antibiotics, percentage of antibiotic course accounted for by outpatient antibiotics, percentage of patients with antibiotic order changes during hospital stay, percent overuse based on discharging services and presence of infectious diseases consult. Data were analyzed using descriptive statistics for the overall cohort, with additional comparative analyses performed between patients with and without antibiotic overuse using SPSS (IBM Corp., 2024).

Results: Nearly half (47/100, 47%) of patients experienced antibiotic overuse at hospital discharge. Overuse was driven primarily by excess duration of therapy, while unnecessary antibiotic initiation and suboptimal use of fluoroquinolones was less common. Among patients with overuse, the median number of excess antibiotic days was 3 days (IQR 2,5). The median total duration of therapy was 8 days (IQR 7,10), compared with a median ideal duration of 5 days (IQR 3,7). Most antibiotic exposure occurred in the outpatient setting (78%). When comparing patients with and without antibiotic overuse, there was no difference in overuse based on diagnosis, demographics, insurance status, or discharging service. More patients who experienced antibiotic overuse received a dose in the emergency department (17% vs. 3%, P = 0.044).

Conclusions: Antibiotic overuse at discharge for uncomplicated infections is common at this institution and is primarily driven by excess duration of therapy. The findings from this study help support prior literature and highlight opportunities for antimicrobial stewardship at transitions of care. Direction of future studies may include pharmacist-led interventions at the time of discharge to influence durations of therapy, and further evaluation of predictors of antibiotic overuse at discharge.