Unnecessary antibiotics for asthma linked to longer hospital stay, elevated cost
Prescribing antibiotics despite no indication of infection to patients hospitalized with asthma was associated with longer hospital stay, a higher risk of antibiotic-related diarrhoea, and elevated hospitalization costs, according to a study presented at the recent American Thoracic Society conference (ATS 2018).
“Our results strengthen the evidence that antibiotics should not be prescribed routinely in adult patients hospitalized with asthma,” said study lead author Associate Professor Mihaela S. Stefan from the University of Massachusetts Medical School, Springfield, Massachusetts, US.
In this retrospective cohort study, Stefan and co-authors assessed data of 22,043 adult patients (aged >18 years) admitted to 554 acute care hospitals in the US for asthma exacerbation between January 2015 and December 2016. Patients had to be receiving systemic corticosteroids to be included in the study, while patients who required antibiotics for other indications (eg, sinus infection, bronchitis, pneumonia, emphysema, sepsis) were excluded.
Of the cohort, 46.1 percent received antibiotics for ≥2 days initiated within the first 2 days of hospitalization. Compared with those who did not receive antibiotics, the patients who did tended to be older (mean age, 50.5 vs 46.6 years), Caucasian (49.6 percent vs 41.5 percent), and smokers (7.6 percent vs 5.5 percent).
Length of hospitalization appeared to be longer in patients who received antibiotics compared with those who did not (mean, 4.4 vs 3.4 days; p<0.0001). [ATS 2018, abstract 16204]
Compared with patients who did not receive antibiotics, those who did also incurred higher hospitalization costs (mean, US$ 6,427 vs 5,387) and had an elevated risk of experiencing antibiotic-related diarrhoea (odds ratio [OR], 1.55, 95 percent confidence interval [CI], 1.16–2.08).
Risk of treatment failure, defined as invasive or noninvasive mechanical ventilation, admission to the intensive care unit after 2 days of hospitalization, in-hospital mortality, or readmission to hospital due to asthma exacerbation within 30 days of discharge, was comparable between patients who did and did not receive antibiotics (5.56 percent vs 5.64 percent, OR, 1.02, 95 percent CI, 0.88–1.17).
“Clinical guidelines, including the Global Initiative for Asthma, state that there is no role for antibiotics in asthma exacerbations unless there is strong evidence of lung infection,” said Stefan.
“[However], more than half of patients hospitalized for asthma receive antibiotics in the absence of a clear indication [though] few studies have assessed whether antibiotics could be beneficial in these patients,” she said.
“All hospitals should assess their practice in caring for patients hospitalized with asthma and increase their antibiotic stewardship,” suggested Stefan.