TOPLINE

Implementation of expected practice guidelines at a tertiary care hospital was associated with increased use of oral and long-acting intravenous (PO/LAIV) antibiotics for serious bacterial infections and lower odds of 3-month readmissions; however, length of stay did not differ significantly before and after guideline implementation.

METHODOLOGY

• Researchers conducted a quasi-experimental pre/post study to evaluate whether expected practice guidelines released in November 2022 reduced inpatient resource use.
• They reviewed 139 manually adjudicated encounters (mean age of patients, 53.3 years; 53.2% men) from January 2018 to October 2024, involving adults aged 18 years or older with infectious diseases consults and serious infections including native valve endocarditis, bacteremia, osteomyelitis, and joint infection.
• The primary outcome was length of stay, while secondary outcomes included inpatient antibiotic days, 3-month readmission, PO/LAIV antibiotic use, microbiologic failure, and adverse drug events.
• Researchers compared these outcomes before and after implementation of the guidelines.

TAKEAWAY

• No significant differences were observed in length of stay (adjusted rate ratio [aRR], 0.91; 95% CI, 0.74-1.13; P = .39) or inpatient intravenous antibiotic days (aRR, 0.95; 95% CI, 0.78-1.16; P = .62) between the pre- and postintervention periods.
• PO/LAIV antimicrobial therapy was used more often after the intervention than before it (60.0% vs 42.0%; P = .034), and postimplementation encounters were associated with higher odds of PO/LAIV use at discharge (adjusted odds ratio [aOR], 2.77; 95% CI, 1.28-5.99; P = .01).
• Encounters occurring after guideline release were associated with lower odds of 3-month all-cause readmission (aOR, 0.37; 95% CI, 0.17-0.77; P = .008).
• Patients who received PO/LAIV therapy had significantly higher rates of microbiologic treatment failure than those who did not (11.3% vs 1.5%; P = .03), though adverse drug events did not differ significantly between groups (2.8% vs 4.4%; P = .68).

IN PRACTICE

“This study found that implementation of an expected practice intervention focused on prescribing PO/LAIV therapy was associated with a meaningful increase in PO/LAIV therapy use and an accompanying reduction in readmissions at one large tertiary care hospital,” the authors of the study wrote, concluding that “these findings support existing evidence that expected practice can be a valuable tool in antimicrobial stewardship that has the potential to positively influence clinician prescribing behavior in a low-barrier, low-cost manner.”

SOURCE

The study was led by William Bradford, MD, MSPH, Division of Infectious Diseases, University of Alabama at Birmingham. It was published online on July 1, 2026, in Open Forum Infectious Diseases.

LIMITATIONS

It was a retrospective, single-center study, and residual confounding was likely. The study did not assess guideline adherence or account for unrelated temporal trends.

DISCLOSURES

Bradford disclosed receiving support through grants from the Agency for Healthcare Research and Quality. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.