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

Created on 10 Jul 2026

Authors

William Bradford, Joshua Stripling, Jay Olivet, John Grissom, Nomin Bold, Katia Bruxvoort, Russell Griffin

Published in

Open forum infectious diseases. Volume 13. Issue 7. Pages ofag396. Epub Jul 01, 2026.

Abstract

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 US tertiary care hospital in November of 2022.
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.
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 = .03). On multivariable analysis, LOS did not differ (adjusted rate ratio [aRR] 0.91; 95% CI, .74-1.13), nor did inpatient intravenous antibiotic days (aRR 0.95; 95% CI, .78-1.16). Post-implementation encounters had lower odds of 3-month all cause readmission (adjusted odds ratio [aOR] 0.37; 95% CI, .17-.77) and higher odds of PO/LAIV use at discharge (aOR 2.77; 95% CI, 1.28-5.99).
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.

PMID:
42428771
Bibliographic data and abstract were imported from PubMed on 10 Jul 2026.

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