A comprehensive assessment of post-discharge antibiotic use across an integrated healthcare system

Antibiotics prescribed at hospital discharge are difficult to capture electronically for surveillance purposes unless patients are discharged to home with oral antibiotics. Our goal was to estimate the proportion of post-discharge antibiotics that are administered either in post-acute care facilities or via outpatient parenteral antibiotic therapy (OPAT) programs among patients discharged from Veterans Health Administration (VHA) hospitals.

We performed a retrospective study of all acute-care VHA admissions discharged during 2018-2021. The primary outcome was post-discharge antibiotic length of therapy, defined as the number of days of antibiotic exposure prescribed or recommended by inpatient providers at hospital discharge. Data on post-discharge antibiotic use was measured electronically for some discharge locations and estimated by performing manual chart reviews in randomly selected cases discharged to other locations.

129 VHA hospitals.

There were 1,972,940 admissions, and 42.6% received inpatient antibiotics; 89.8% of patients were discharged to the community and 10.2% to post-acute care. The frequency of receiving post-discharge antibiotics varied by discharge location. Based on our calculations, 32.8% of all post-discharge days of antibiotic exposure occurred in post-acute care or via OPAT. Overall, 43.9% of all hospital-associated days of antibiotic exposure were administered during the hospital stay and the remaining 56.1% qualified as post-discharge.

A third of all post-discharge antibiotics were dispensed in post-acute care facilities or by OPAT programs. These findings have implications for comparing hospitals on their post-discharge antibiotic use, because antibiotic data for patients discharged to these locations is often missing or difficult to collect.