The relationship of prescriber training level to restricted antibiotic prescribing appropriateness at a tertiary academic hospital: a retrospective study.

Objective: This study aimed to compare appropriateness of restricted antimicrobial prescriptions, as assessed by antimicrobial stewardship program (ASP) prospective audit and feedback (PAF), between those ordered by medical trainees versus staff. Secondary objectives were to determine whether certain timing factors and other independent variables impacted prescription appropriateness. Design: Single center, retrospective cohort study. Setting: The University of Alberta Hospital a 700-bed tertiary care hospital in Edmonton, Canada. Participants: Prescriptions of six health-authority restricted antibiotics subject to ASP PAF between 2018 and 2023. Cases were excluded if prescriber role or prescription dates or times were unavailable. Methods: Data from a local ASP quality improvement database was extracted. Multiple logistic regression analysis was completed with adjusted odds ratios (aOR) reported. Results: A total of 3,687 restricted antibiotic prescriptions subjected to PAF were included in this study, of which 1,163 (31.5%) were assessed as not appropriately prescribed. Prescriptions written by medical trainees did not have higher odds of appropriateness compared to staff (aOR 1.09 [95% CI 0.94-1.28], Conclusions: No differences were noted in restricted antibiotic prescription appropriateness between medical trainees and staff. Weekend prescriptions were less likely to be appropriate. Improved appropriateness over time may be multifactorial, including implementation of ASP preceding the pandemic. Further studies examining timing factors associated with appropriateness are needed.