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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Association Between Peer Comparison Feedback and Hospitalist Antibiotic Prescribing.

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  • 1Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia.

JAMA Network Open
|April 28, 2026
PubMed
Summary

Peer comparative feedback on inpatient antibiotic prescribing did not change hospitalists' rates of prescribing broad-spectrum antibiotics for hospital-onset infections. Further efforts are needed to improve the effectiveness of these reports.

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Area of Science:

  • Health Services Research
  • Infectious Diseases
  • Quality Improvement

Background:

  • Antibiotic overuse poses risks to patients and healthcare systems.
  • Inpatient antibiotic prescribing feedback is less studied than in outpatient settings.

Purpose of the Study:

  • To evaluate the impact of peer comparative feedback on inpatient antibiotic prescribing rates among hospitalists.
  • To assess changes in the prescription of broad-spectrum antibiotics for hospital-onset infections (BS-HO antibiotics).

Main Methods:

  • A quality improvement study with a stepped-wedge cluster design across 5 acute care facilities.
  • 169 hospitalists received bimonthly email reports comparing their antibiotic prescribing (days of therapy) to peers.
  • Prescribing rates for BS-HO antibiotics were analyzed using multivariable models accounting for patient characteristics and time trends.

Main Results:

  • The intervention of peer comparative feedback was not significantly associated with lower BS-HO antibiotic prescribing rates (RR, 0.97; 95% CI, 0.91-1.04).
  • Prescribing rates were higher for clinicians managing more sepsis or end-stage kidney disease patients.
  • A slight decrease in prescribing was observed over sequential reporting periods.

Conclusions:

  • Peer comparative prescribing reports did not alter hospitalists' antibiotic prescribing habits for hospital-onset infections.
  • The findings indicate a need for enhanced strategies to improve the utility and impact of such feedback mechanisms.