1816. Large-Scale Comparison of Antibiotic Prescription Guidelines Uncovers Disparities Among Stewardship Approaches

Abstract

BackgroundThe accrediting institution for hospitals in the United States made antimicrobial stewardship programs (ASPs) mandatory in 2017. In part due to the relatively new status of ASPs, standards surrounding the content produced by these programs are still in their infancy. One product of ASPs are antibiotic prescription guidelines, which vary greatly across hospitals in terms of their structure and content.MethodsIn this study, we reviewed 70 publicly available antibiotic prescription guidelines published from 2006 to 2017, originating from 12 countries on four continents to evaluate their coverage and variability.ResultsGuidelines varied greatly in terms of their length, word count, page layout, revision frequency, and number of contributing authors. In terms of content, guidelines were discordant in their inclusion of cost information, restricted antibiotics, disclaimers, and pediatric recommendations. Guidelines also varied in their approach, in that some were focused on how to approach specific diagnoses, while others were focused on the usage of particular antibiotics. Many guidelines made use of decision trees to convey information, especially for the diagnosis and treatment of Clostridium difficile-associated diarrhea, cellulitis, and community-acquired pneumonia; however, the number of decision trees included in a hospital’s guideline varied greatly. A small minority of guidelines included identification trees for classifying bacterial isolates. Guidelines also notably differed in the extent to which they incorporated local antibiotic susceptibility data. Some guidelines did not report antibiogram summaries, while others displayed information for 5 to 34 organisms. Furthermore, we assessed guidelines’ prescription recommendations for 12 common bacterial infections and found large variation in suggested prescribing practices across hospitals.ConclusionTo our knowledge, this study provides the first large-scale analysis of antibiotic prescription guidelines and highlights the extreme variation in approaches to stewardship across hospitals. Furthermore, our analysis provides a baseline of current practices for future comparison, and initiates a discussion into what comprises a model antibiotic prescription guideline.Disclosures All authors: No reported disclosures.