Impact of Institutional Expected Practice Guidelines on Oral and Long-acting Intravenous Antibiotic Use for Serious Bacterial Infections

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ID: 319316
2026
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Abstract
Abstract Background Expected practice interventions are a low resource antimicrobial stewardship strategy to standardize prescribing behavior by clinicians. An expected practice intervention to encourage use of oral and long-acting IV (PO/LAIV) antibiotics for serious infections was implemented at a U.S. tertiary care hospital in November of 2022. Methods We conducted a quasi-experimental pre/post study to evaluate the effect of guideline release on a primary outcome of length of stay (LOS) and secondary outcomes of inpatient antibiotic days, 3-month readmission, PO/LAIV antibiotic use, microbiologic failure, and adverse drug events. We also assessed key factors associated with use of PO/LAIV therapy receipt. Results Among 139 encounters, we found a significant increase in the proportion of encounters in which PO/LAIV therapy was prescribed after the intervention (42.0% vs 60.0%, p = 0.03). On multivariable analysis, LOS did not differ (adjusted rate ratio [aRR] 0.91; 95% CI, 0.74–1.13), nor did inpatient intravenous antibiotic days (aRR 0.95; 95% CI, 0.78–1.16). Post-implementation encounters had lower odds of 3-month all cause readmission (adjusted odds ratio [aOR] 0.37; 95% CI, 0.17–0.77) and higher odds of PO/LAIV use at discharge (aOR 2.77; 95% CI, 1.28–5.99). Conclusions Expected practice intervention implementation was associated with an increase in PO/LAIV therapy use and a reduction in readmission, supporting its role as a promising, low-resource antimicrobial stewardship strategy warranting further prospective evaluation.
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openalex_W7166827271 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors William Bradford, Joshua Stripling, Jay Olivet, John Grissom, Nomin Bold, Katia Bruxvoort, Russell Griffin
Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag396
URL
https://doi.org/10.1093/ofid/ofag396
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