Prospective Audit and Feedback by Antibiotic Stewardship Teams to Reduce Antibiotic Overuse at Hospital Discharge

This multicentre stepped-wedge cluster-randomized trial across 10 hospitals evaluated whether a discharge-focused antimicrobial stewardship intervention—combining guideline dissemination with prospective audit and feedback for patients nearing discharge—could reduce antibiotic overuse at hospital discharge. Among more than 21,000 admissions, the intervention did not reduce the proportion of patients prescribed antibiotics after discharge, nor did it shorten postdischarge or inpatient antibiotic duration, length of stay, or 30-day readmission rates. However, detailed chart review showed a significant improvement in prescribing quality, with optimal antibiotic use at discharge more common during the intervention period. Most surveyed prescribers perceived the initiative as beneficial. Overall, while discharge-focused audit and feedback improved the appropriateness of antibiotic prescribing, it did not reduce overall antibiotic use, indicating that additional or alternative stewardship strategies are needed at this transition of care.