Antibiotic Prescribing for Rhinosinusitis Outpaces Bacterial Infection Incidence

Abstract Background Respiratory viral panels (RVPs) can detect multiple viral pathogens and give clinicians diagnostic confidence to discontinue antibiotics. However, relatively little is known about how these tests influence antibiotic prescribing in hospital settings. Methods This was a 26-month retrospective chart review of patients with positive RVPs. Hospitalized adults receiving antibiotics at the time of the RVP were included. Exclusion criteria were: ICU care, solid-organ transplantation (SOT), positive RVP for influenza, positive bacterial cultures, and antibiotic administration for bacterial infection (e.g., cellulitis). A multivariate linear regression model was created to investigate associations with longer antibiotic use after a positive RVP. Results 1,346 patients were screened and 242 met inclusion criteria. Primary reasons for exclusion were SOT, ICU, and influenza diagnosis. Patients were a median age of 60.5 years [IQR 51,70] and 35.5% were men. The median length of stay (LOS) was 4 days [IQR 3.6]. 233 patients (6.3%) had chest radiology performed, of which 71 (30.4%) had possible pneumonia noted. 50 (20.7%) were immunocompromised (IC). 199 (82.2%) had a history of pulmonary disease, most commonly COPD. Rhinovirus was isolated in 156 patients (64.5%), followed by metapneumovirus (35, 14.9%) and RSV (32, 13.3%). Antibiotics were given for a median total of 3 days [IQR 3.6]; they were discontinued within 24 hours of the RVP result in 107 patients (44.2%). Conclusion In this population of patients with viral infection and no discernable bacterial infection, 44.2% of patients had antibiotics discontinued within 24 hours of RVP results. On multivariate linear regression analysis, younger age, longer LOS, and IC status were associated with longer antibiotic duration after a positive RVP. A comparison with patients with negative RVP results could reveal if the test prompted discontinuation. Disclosures All authors: No reported disclosures.

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Antibiotics Prescribing in Intensive Care Settings during the COVID-19 Era: A Systematic Review

Antibiotics ◽

10.3390/antibiotics10080935 ◽

2021 ◽

Vol 10 (8) ◽

pp. 935

Author(s):

Lubna I. Abu-Rub ◽

Hana A. Abdelrahman ◽

Al-Reem A. Johar ◽

Hashim A. Alhussain ◽

Hamad Abdel Hadi ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Bacterial Infection ◽

Observational Studies ◽

English Language ◽

Bacterial Species ◽

Final Analysis ◽

Generation Cephalosporin ◽

Antibiotic Prescribing ◽

Icu Patients

The prevalence of patients admitted to intensive care units (ICUs) with SARS-CoV-2 infection who were prescribed antibiotics is undetermined and might contribute to the increased global antibiotic resistance. This systematic review evaluates the prevalence of antibiotic prescribing in patients admitted to ICUs with SARS-CoV-2 infection using PRISMA guidelines. We searched and scrutinized results from PubMed and ScienceDirect databases for published literature restricted to the English language up to 11 May 2021. In addition, we included observational studies of humans with laboratory-confirmed SARS-CoV-2 infection, clinical characteristics, and antibiotics prescribed for ICU patients with SARS-CoV-2 infections. A total of 361 studies were identified, but only 38 were included in the final analysis. Antibiotic prescribing data were available from 2715 patients, of which prevalence of 71% was reported in old age patients with a mean age of 62.7 years. From the reported studies, third generation cephalosporin had the highest frequency amongst reviewed studies (36.8%) followed by azithromycin (34.2%). The estimated bacterial infection in 12 reported studies was 30.8% produced by 15 different bacterial species, and S. aureus recorded the highest bacterial infection (75%). The fundamental outcomes were the prevalence of ICU COVID-19 patients prescribed antibiotics stratified by age, type of antibiotics prescribed, and the presence of co-infections and comorbidities. In conclusion, more than half of ICU patients with SARS-CoV-2 infection received antibiotics, and prescribing is significantly higher than the estimated frequency of identified bacterial co-infection.

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The Effect of Amoxicillin in Adult Patients Presenting to Primary Care with Acute Cough Predicted to Have Pneumonia or a Combined Viral-Bacterial Infection

Antibiotics ◽

10.3390/antibiotics10070817 ◽

2021 ◽

Vol 10 (7) ◽

pp. 817

Author(s):

Robin Bruyndonckx ◽

Beth Stuart ◽

Paul Little ◽

Niel Hens ◽

Margareta Ieven ◽

...

Keyword(s):

Primary Care ◽

Bacterial Infection ◽

Controlled Trial ◽

Symptom Duration ◽

Antibiotic Prescribing ◽

Clinical Prediction ◽

Acute Cough ◽

Clinical Prediction Rules ◽

Prediction Rules ◽

Combined Infection

While most cases of acute cough are self-limiting, antibiotics are prescribed to over 50%. This proportion is inappropriately high given that benefit from treatment with amoxicillin could only be demonstrated in adults with pneumonia (based on chest radiograph) or combined viral–bacterial infection (based on modern microbiological methodology). As routine use of chest radiographs and microbiological testing is costly, clinical prediction rules could be used to identify these patient subsets. In this secondary analysis of data from a multicentre randomised controlled trial in adults presenting to primary care with acute cough, we used prediction rules for pneumonia or combined infection and assessed the effect of amoxicillin in patients predicted to have pneumonia or combined infection on symptom duration, symptom severity and illness deterioration. In total, 2056 patients that fulfilled all inclusion criteria were randomised, 1035 to amoxicillin, 1021 to placebo. Neither patients with a predicted pneumonia nor patients with a predicted combined infection were significantly more likely to benefit from amoxicillin. While the studied clinical prediction rules may help primary care clinicians to reduce antibiotic prescribing for low-risk patients, they did not identify adult acute cough patients that would benefit from amoxicillin treatment.

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Procalcitonin and Proinflammatory Cytokines in Early Diagnosis of Bacterial Infections after Bronchoscopy

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.208 ◽

2019 ◽

Vol 7 (6) ◽

pp. 913-919 ◽

Cited By ~ 1

Author(s):

Mohsen Farrokhpour ◽

Arda Kiani ◽

Esmaeil Mortaz ◽

Kimia Taghavi ◽

Amir Masoud Farahbod ◽

...

Keyword(s):

Bacterial Infection ◽

Proinflammatory Cytokines ◽

Bacterial Infections ◽

Inflammatory Responses ◽

Fiberoptic Bronchoscopy ◽

Control Group ◽

P Value ◽

Case Group ◽

Antibiotic Prescribing ◽

Threshold Point

BACKGROUND: Fiberoptic bronchoscopy (FOB) guided bronchoalveolar lavage (BAL) remains as the chief diagnostic tool in respiratory disorders. 1.2-16% of patients frequently experience fever after bronchoscopy. To exclude the need for multiple antibiotic prescribing in patients with post-bronchoscopy fever, the presence of the self-limiting inflammatory responses should be excluded. AIM: The current study was conducted to test the serum of patients undergoing bronchoscopy for some proinflammatory cytokines including Tumor Necrosis Factor-alpha (TNF-ɑ), Interleukin-1beta (IL-1β), Interleukin-8 (IL-8) and Interleukin-6 (IL-6) and the value of Procalcitonin (PCT). MATERIAL AND METHODS: Current case-control study was conducted at the National Research Institute of Tuberculosis and Lung Disease in Iran. Nineteen patients (48.72%) that attended with a reasonable sign for a diagnostic bronchoscopy from January 2016 to December 2017 were included in the case group. The control group consisted of 20 patients who underwent a simple bronchoscopy and without FOB-BAL. The laboratory findings for PCT concentrations and cytokine levels in the three serum samples (before FOB-BAL (t0), after 6 hr. (t1), and at 24 hr. past (t2) FOB-BAL) were compared between two groups. RESULTS: The frequency of post-bronchoscopy fever was 5.12, and the prevalence of post-bronchoscopy infectious fever was 2.56%. PCT level was considerably higher in the patient with a confirmed bacterial infection when compared to other participants (p-value < 0. 05). Interestingly, IL-8 level in the bacterial infection proven fever patient was higher than in other patients (p < 0.001). IL-8 levels displayed a specificity of 72.7% and a sensitivity of 100%, at the threshold point of 5.820 pg/ml. PCT levels had a specificity of 84% and a sensitivity of 81%, at the threshold point of 0.5 ng/ml. CONCLUSION: The present findings show that in patients with fever after bronchoscopy, PCT levels and IL-8 levels are valuable indicators for antibiotic therapy, proving adequate proof for bacterial infection. The current findings also illustrate that to monitor the serum levels of PCT and proinflammatory cytokines in the patients undergoing FOB-BAL, the best time is the 24-hour postoperative bronchoscopy.

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Antibiotic prescribing among inpatients with infectious and non-infectious indications in obstetrics and gynaecology departments at two tertiary care hospitals in Central India

10.21203/rs.2.15649/v1 ◽

2019 ◽

Author(s):

Anna Machowska ◽

Kristoffer Landstedt ◽

Cecilia Stålsby Lundborg ◽

Megha Sharma

Keyword(s):

Antibiotic Resistance ◽

Bacterial Infection ◽

Tertiary Care ◽

Central India ◽

Prescribing Patterns ◽

Fixed Dose ◽

Antibiotic Prescribing ◽

Surgical Indications ◽

Obstetrics And Gynaecology ◽

Tertiary Care Hospitals

Abstract Background : Patients in departments such as obstetrics and gynaecology (OBGY) are at high risk of life-threatening infections, thus are prescribed antibiotics extensively. Use of antibiotics leads to increasing antibiotic resistance. Antibiotic surveillance is one of the cornerstones to combat antibiotic resistance. However, hospital-based, department specific surveillance data of prescribed antibiotics are scarce, especially in low- and middle-income countries. Aim: To describe and compare antibiotic prescribing patterns among the inpatients at OBGY departments of two tertiary care hospitals, one teaching (TH) and one non-teaching (NTH), in Central India. Methods: Data of all inpatients was collected manually for three years and analysed using demographics, length of hospital stay, diagnoses and prescribed antibiotics including dose, duration, and frequency and defined daily dose per 1000 inpatients were calculated. The patients were divided into, infectious and non-infectious categories and further into surgical, non-surgical and possible surgical indications. The data was coded based on the Anatomical Therapeutic Chemical classification system and the International Classification of Disease system version-10. Results: Of the total 5558 admitted patients, 2044 (81%) in the TH and 2567 (85%) in the NTH received antibiotic treatment (p<0.001). In both hospitals, a majority of the patients with surgical indications were prescribed antibiotics (87% to 100%). Prescribing of the fixed-dose combinations of antibiotics (FDCs) and use of brand names was more common at the NTH then at the TH. A majority of the inpatients who neither had surgery nor had any confirmed bacterial infection also received antibiotic prescriptions (TH-71%, NTH-75%). Overall, higher DDD/1000 patients were prescribed in the TH compared to the NTH in both categories. Conclusions: More frequent prescribing of broad-spectrum antibiotics, including FDCs and higher brand-name prescribing at the NTH compared to the TH, is a point of concern. Antibiotics prescribed to the inpatients having non-bacterial infection indications is another point of concern and requires urgent action. Investigation of underlying reasons for prescribing antibiotics for unindicated diagnoses and the development and implementation of antibiotic stewardship programs are recommended measures to improve the prescribing of antibiotics.

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Antibiotic prescribing among inpatients with infectious and non-infectious indications in obstetrics and gynecology departments at two tertiary care hospitals in Central India

10.21203/rs.2.10544/v1 ◽

2019 ◽

Author(s):

Anna Machowska ◽

Kristoffer Landstedt ◽

Cecilia StålsbyLundborg ◽

Megha Sharma

Keyword(s):

Antibiotic Resistance ◽

Bacterial Infection ◽

Tertiary Care ◽

Central India ◽

Prescribing Patterns ◽

Fixed Dose ◽

Obstetrics And Gynecology ◽

Antibiotic Prescribing ◽

Surgical Indications ◽

Tertiary Care Hospitals

Abstract Background: Patients in departments such as obstetrics and gynecology (OBGY) are at high risk of life-threatening infections, thus are prescribed antibiotics extensively. Use of antibiotics leads to increasing antibiotic resistance. Antibiotic surveillance is one of the cornerstones to combat antibiotic resistance. However, hospital-based, department specific surveillance data of prescribed antibiotics are scarce especially in low- and middle-income countries. Aim: To describe and compare antibiotic prescribing patterns among the inpatients at OBGY departments of two tertiary care hospitals, one teaching (TH) and one non-teaching (NTH) in Central India. Methods: Data of all inpatients was collected manually for three years and analyzed using demographics, length of hospital stay, diagnoses and prescribed antibiotics including dose, duration, and frequency and defined daily dose per 1000 inpatients were calculated. The patients were divided into, infectious and non-infectious categories and further into surgical, non-surgical and possible surgical indications. The data was coded based on the Anatomical Therapeutic Chemical classification system and the International Classification of Disease system version-10. Results: Of the total 5558 admitted patients, 2044 (81%) in the TH and 2567 (85%) in the NTH received antibiotic treatment (p<0.001). In both hospitals, a majority of the patients with surgical indications were prescribed antibiotics (87% to 100%). Prescribing of the fixed-dose combinations of antibiotics (FDCs) and use of brand names was more common at the NTH then at the TH. A majority of the inpatients who neither had surgery nor had any confirmed bacterial infection also received antibiotic prescriptions (TH-71%, NTH-75%). Overall, higher DDD/1000 patients were prescribed in the TH compared to the NTH in both categories. Conclusions: More frequent prescribing of broad-spectrum antibiotics including FDCs and higher brand-name prescribing at the NTH compared to the TH is a point of concern. Antibiotics prescribed to the inpatients having non-bacterial infection indications is another point of concern and requires urgent action. Investigation of underlying reasons for prescribing antibiotics for unindicated diagnoses and the development and implementation of antibiotic stewardship programs are recommended measures to improve the prescribing of antibiotics.

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