Indications for Antibiotic Orders: How Accurate Are They?

BACKGROUND: Documentation of antibiotic indications at the time of ordering can provide helpful information for antimicrobial stewardship programs to track antibiotic utilization patterns and improve antibiotic prescribing. Yet accuracy of indications is not fully understood; antibiotics are often ordered empirically without a clear-cut indication, and orders are not often updated once a diagnosis has been made, or the first listed option may be chosen for convenience. As hospitals are implementing antibiotic indications at the time of order entry to meet stewardship standards, our study sought to assess the accuracy of indications in an antibiotic order compared with true indication for the drug. METHODS: Indications for antibiotics, selected from a standardized list, are a required field in the computerized order entry system at our institution. Study investigators, including at least one infectious diseases attending, performed an in-depth post-hoc review to assess antibiotic indication and appropriateness. The frequency that the true antibiotic indication, as assessed by study investigators, matched with the indication in the antibiotic order was analyzed. RESULTS: Of 396 antibiotic orders reviewed by the study team, 100 had discordant indications between what was written in the order and the investigator-assessed indication (25.3%). The highest rates of discordance were seen with GU-UTI (11/18 incorrect, 61.1%) followed by bacteremia/sepsis (44 of the 116 incorrect, 37.9%). For GU-UTI, the most common investigator assessed true indications were pulmonary including CAP, HAP and empyema. For bacteremia/sepsis, the discordance was often due to a more specific diagnosis or source being identified. CONCLUSION: Discordant indications between what was entered at the time of initial order compared with an investigator assessed indication occurred frequently. This finding is of concern as evaluations of antibiotic appropriateness, utilization and benchmarking by the antimicrobial stewardship team rely on the accuracy of indications in the system. Entering a revised indication during an antibiotic time out could improve the accuracy of antibiotic indications and antimicrobial stewardship data. DISCLOSURES: All authors: No reported disclosures.