Understanding the role of antibiotic-associated adverse events in influencing antibiotic decision-making

Jerald P Cherian; Taylor N Helsel; George F Jones; Zunaira Virk; Alejandra Salinas; Suzanne M Grieb; Eili Y Klein; Pranita D Tamma; Sara E Cosgrove; Centers for Disease Control and Prevention’s Prevention Epicenters Program

doi:10.1017/ash.2024.2

Understanding the role of antibiotic-associated adverse events in influencing antibiotic decision-making

Antimicrob Steward Healthc Epidemiol. 2024 Jan 30;4(1):e13. doi: 10.1017/ash.2024.2. eCollection 2024.

Authors

Jerald P Cherian¹, Taylor N Helsel¹, George F Jones¹, Zunaira Virk¹, Alejandra Salinas¹, Suzanne M Grieb², Eili Y Klein³, Pranita D Tamma⁴, Sara E Cosgrove¹; Centers for Disease Control and Prevention’s Prevention Epicenters Program

Affiliations

¹ Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Pediatrics, Center for Child and Community Health Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Abstract

Objective: To (1) understand the role of antibiotic-associated adverse events (ABX-AEs) on antibiotic decision-making, (2) understand clinician preferences for ABX-AE feedback, and (3) identify ABX-AEs of greatest clinical concern.

Design: Focus groups.

Setting: Academic medical center.

Participants: Medical and surgical house staff, attending physicians, and advanced practice practitioners.

Methods: Focus groups were conducted from May 2022 to December 2022. Participants discussed the role of ABX-AEs in antibiotic decision-making and feedback preferences and evaluated the prespecified categorization of ABX-AEs based on degree of clinical concern. Thematic analysis was conducted using inductive coding.

Results: Four focus groups were conducted (n = 15). Six themes were identified. (1) ABX-AE risks during initial prescribing influence the antibiotic prescribed rather than the decision of whether to prescribe. (2) The occurrence of an ABX-AE leads to reassessment of the clinical indication for antibiotic therapy. (3) The impact of an ABX-AE on other management decisions is as important as the direct harm of the ABX-AE. (4) ABX-AEs may be overlooked because of limited feedback regarding the occurrence of ABX-AEs. (5) Clinicians are receptive to feedback regarding ABX-AEs but are concerned about it being punitive. (6) Feedback must be curated to prevent clinicians from being overwhelmed with data. Clinicians generally agreed with the prespecified categorizations of ABX-AEs by degree of clinical concern.

Conclusions: The themes identified and assessment of ABX-AEs of greatest clinical concern may inform antibiotic stewardship initiatives that incorporate reporting of ABX-AEs as a strategy to reduce unnecessary antibiotic use.