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

Background: 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. Methods: 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. Results: 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%, Conclusions: 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.