An evaluation of provider-chosen antibiotic indications as a targeted antimicrobial stewardship intervention

Background: Provider-entered indications for antibiotics have been recommended as a tracking tool for antibiotic stewardship programs. The accuracy and utility of these indications are unknown. Methods: Drug-specific lists of evidence-based indications were integrated into an electronic health system as an ordering hard-stop. We reviewed antibiotic orders with provider-entered indications to determine whether the chosen indication matched the documentation and whether antibiotic use was appropriate. Results: One hundred fifty-five antibiotic orders were reviewed. Clinical documentation supported the entered indication in 80% of vancomycin orders, 78% of cefepime orders, and 74% of fluoroquinolone orders. The clinical appropriateness for vancomycin, cefepime, and fluoroquinolones were 94%, 100%, and 68%, respectively. When providers chose indications from the list as opposed to choosing “other” and entering free text, antibiotic orders were significantly more likely to be appropriate (odds ratio, 5.8; P =.001) but also less likely to match clinical documentation (odds ratio, 0.25; P =.0043). Discussion: Provider-chosen indications are, overall, an accurate reflection of the true reason for antibiotic use at our institution. Providers frequently documented reasons for fluoroquinolone use that were not among the provided indications. Conclusion: Selecting an indication from an evidence-based list as opposed to free-text indications increases the odds that antibiotic agents will be used appropriately.