Antibiotic prescribing for acute respiratory infections in New York City: A model for collaboration

AbstractObjectiveTo assess the status of antibiotic prescribing in the ambulatory setting for adult patients with acute respiratory infections (ARIs) and to identify opportunities and barriers for outpatient antibiotic stewardship programs (ASPs).DesignMixed methods including point prevalence using chart reviews, surveys, and collaborative learning.SettingHospital-owned clinics in the New York City area.Participants/PatientsIn total, 31 hospital-owned clinics from 9 hospitals and health systems participated in the study to assess ARI prescribing practices for patients >18 years old.InterventionsEach clinic performed a survey of current stewardship practices, retrospective chart reviews of prescribing in 30 randomly selected ARI patients from October 2015 to March 2016, and surveys of provider characteristics and knowledge. Clinics participated in collaborative learning with peers and experts in antibiotic stewardship and collected data from June 2016 to August 2016. Sites received data reports by individual clinic, aggregated by hospital, and were compared among participating clinics.ResultsFew sites had outpatient stewardship activities. The retrospective review of 1,004 ARI patients revealed that 37.3% of ARI patients received antibiotics, with significant variation in prescribing practices among sites (17.4%–71.0%; P<.001). Macrolides were the most commonly prescribed antibiotics. Most of the 302 respondents recognized the need for tools to assist in prescribing.ConclusionsThis collaborative study establishes a baseline assessment of the status of outpatient ASPs in New York City. It provides hospitals, health systems, and individual clinics with specific data to inform their development of stewardship interventions targeting ARIs.

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An antibiotic stewardship programme to reduce inappropriate antibiotic prescribing for acute respiratory infections in rural Chinese primary care facilities: study protocol for a clustered randomised controlled trial

10.21203/rs.3.rs-18556/v1 ◽

2020 ◽

Author(s):

Chao Zhuo ◽

Xiaolin Wei ◽

Zhitong Zhang ◽

Joseph Paul Hicks ◽

Jinkun Zheng ◽

...

Keyword(s):

Primary Care ◽

Antibiotic Stewardship ◽

Respiratory Infections ◽

Inappropriate Prescribing ◽

Antibiotic Prescribing ◽

Acute Respiratory Infections ◽

Care Facilities ◽

Randomised Controlled ◽

Antibiotic Stewardship Programme

Abstract Background: Inappropriate prescribing of antibiotics for acute respiratory infections at primary care level represents the major source of antibiotic misuse in healthcare, and is a major driver for antimicrobial resistance worldwide. In this study we will develop, pilot and evaluate the effectiveness of a comprehensive antibiotic stewardship programme in China’s primary care hospitals to reduce inappropriate prescribing of antibiotics for acute respiratory infections among all ages.Methods: We will use a parallel-group, cluster-randomised, controlled, superiority trial with blinded outcome evaluation but unblinded treatment (providers and patients). We will randomise 34 primary care hospitals from two counties within Guangdong province into the intervention and control arm (1:1 overall ratio) stratified by county (8:9 within-county ratio). In the control arm, antibiotic prescribing and management will continue through usual care. In the intervention arm, we will implement an antibiotic stewardship programme targeting family physicians and patients/caregivers. The family physician components include: 1) training using new operational guidelines, 2) improved management and peer-review of antibiotic prescribing, 3) improved electronic medical records and smart phone app facilitation. The patient/caregiver component involves patient education via family physicians, leaflets and videos. The primary outcome is the proportion of prescriptions for acute respiratory infections (excluding pneumonia) that contain any antibiotic(s). Secondary outcomes will address how frequently specific classes of antibiotics are prescribed, how frequently key non-antibiotic alternatives are prescribed and the costs of consultations. We will conduct a qualitative process evaluation to explore operational questions regarding acceptability, cultural appropriateness and burden of technology use, as well as a cost-effectiveness analysis and a long-term benefit evaluation. The duration of the intervention will be 12 months, with another 24 months post-trial long-term follow-up.Discussion: Our study is one of the first trials to evaluate the effect of an antibiotic stewardship programme in primary care settings in a low- or middle-income country (LMIC). All intervention activities will be designed to be embedded into routine primary care with strong local ownership. Through the trial we intend to impact on clinical practice and national policy in antibiotic prescription for primary care facilities in rural China and other LMICs.Trial registration: ISRCTN, ISRCTN96892547. Registered 18 August 2019, http://www.isrctn.com/ISRCTN96892547

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Differences in antibiotic prescriptions between direct-to-consumer telehealth and telehealth in the emergency department

Journal of Telemedicine and Telecare ◽

10.1177/1357633x211034994 ◽

2021 ◽

pp. 1357633X2110349

Author(s):

Peter Yao ◽

Kriti Gogia ◽

Sunday Clark ◽

Hanson Hsu ◽

Rahul Sharma ◽

...

Keyword(s):

Emergency Department ◽

Confidence Interval ◽

Respiratory Infection ◽

Antibiotic Stewardship ◽

Odds Ratio ◽

Acute Respiratory Infection ◽

Respiratory Infections ◽

Antibiotic Prescribing ◽

Acute Respiratory Infections ◽

Direct To Consumer

Background Telemedicine, which allows physicians to assess and treat patients via real-time audiovisual conferencing, is a rapidly growing modality for providing medical care. Antibiotic stewardship is one important measure of care quality, and research on antibiotic prescribing for acute respiratory infections in direct-to-consumer telemedicine has yielded mixed results. We compared antibiotic prescription rates for acute respiratory infections in two groups treated by telemedicine: (1) patients treated via a direct-to-consumer telemedicine application and (2) patients treated via telemedicine while physically inside the emergency department. Methods We included direct-to-consumer telemedicine and emergency department telemedicine visits for patients 18 years and older with physician-coded International Classification of Diseases, Tenth Revision acute respiratory infection diagnoses between November 2016 and December 2018. Patients in both groups were seen by the same emergency department faculty working dedicated telemedicine shifts. We compared antibiotic prescribing rates for direct-to-consumer telemedicine and emergency department telemedicine visits before and after adjustment for age, sex, and diagnosis. Results We identified a total of 468 acute respiratory infection visits: 191 direct-to-consumer telemedicine visits and 277 emergency department telemedicine visits. Overall, antibiotics were prescribed for 47% of visits (59% of direct-to-consumer telemedicine visits vs 39% of emergency department telemedicine visits; odds ratio 2.23; 95% confidence interval 1.53–3.25; P < 0.001). The difference in antibiotic prescribing rates remained significant after adjustment for age, sex, and diagnosis (odds ratio 2.49; 95% confidence interval 1.65–3.77; P < 0.001). Conclusion Patients seen by the same group of physicians for acute respiratory infection were significantly more likely to be prescribed antibiotics by direct-to-consumer telemedicine care compared with telemedicine care in the emergency department. This work suggests that contextual factors rather than evaluation over video may contribute to differences in antibiotic stewardship for direct-to-consumer telemedicine encounters.

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Interactions among common non-SARS-CoV-2 respiratory viruses and influence of the COVID-19 pandemic on their circulation in New York City

10.1101/2021.10.14.21264861 ◽

2021 ◽

Author(s):

Haokun Yuan ◽

Alice Yeung ◽

Wan Yang

Keyword(s):

New York ◽

New York City ◽

York City ◽

Cumulative Incidence ◽

Respiratory Infections ◽

Moving Average ◽

Vaccination Campaign ◽

Respiratory Viruses ◽

Syncytial Virus ◽

The Impact

Background Non-pharmaceutical interventions (NPIs) and voluntary behavioral changes during the COVID-19 pandemic have influenced the circulation of non-SARS-CoV-2 respiratory infections. We aimed to examine interactions among common non-SARS-CoV-2 respiratory virus and further estimate the impact of the COVID-19 pandemic on these viruses. Methods We analyzed incidence data for seven groups of respiratory viruses in New York City (NYC) during Oct 2015 - May 2021 (i.e., before and during the COVID-19 pandemic). We first used elastic net regression to identify potential virus interactions and further examined the robustness of the found interactions by comparing the performance of Auto Regressive Integrated Moving Average (ARIMA) models with and without the interactions. We then used the models to compute counterfactual estimates of cumulative incidence and estimate the reduction during the COVID-19 pandemic period from March 2020 to May 2021, for each virus. Results We identified potential interactions for three endemic human coronaviruses (CoV-NL63, CoV-HKU, and CoV-OC43), parainfluenza (PIV)-1, rhinovirus, and respiratory syncytial virus (RSV). We found significant reductions (by ~70-90%) in cumulative incidence of CoV-OC43, CoV-229E, human metapneumovirus, PIV-2, PIV-4, RSV, and influenza virus during the COVID-19 pandemic. In contrast, the circulation of adenovirus and rhinovirus was less affected. Conclusions Circulation of several respiratory viruses has been low during the COVID-19 pandemic, which may lead to increased population susceptibility. It is thus important to enhance monitoring of these viruses and promptly enact measures to mitigate their health impacts (e.g., influenza vaccination campaign and hospital infection prevention) in the coming months.

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1992. Initial Procalcitonin Level and Antibiotic Practice Patterns Among Patients with Acute Respiratory Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1672 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S668-S668

Author(s):

Jessica K Costales ◽

Jim H Nomura ◽

Wen-Ling Joanie. Chung ◽

Kristen Ironside ◽

John J Sim ◽

...

Keyword(s):

Health System ◽

Real World ◽

Practice Patterns ◽

Respiratory Infections ◽

Antibiotic Use ◽

Primary Diagnosis ◽

Chronic Obstructive ◽

Antibiotic Prescribing ◽

Acute Respiratory Infections ◽

Prescribing Practices

Abstract Background The utility of procalcitonin (PCT)-guided algorithms to decrease antibiotic use has been extensively studied in clinical trials. The guidance that PCT provides as it translates into real-world practice is unclear. This study aims to describe real-world antibiotic prescribing practices in relation to PCT in patients admitted to our US-based health system with acute respiratory infections. Methods Retrospective cohort study of 1,606 adults admitted within our US health system from January 1, 2016 to December 31, 2018 with a primary diagnosis of acute upper or lower respiratory infection with at least one PCT measurement. Antibiotic practice patterns were evaluated using pharmacy analytic information and antibiotic status to note antibiotics given prior to and 36 hours after PCT result. Analysis of discordance with initial PCT level was defined as continuing or starting antibiotics after a low PCT level (PCT ≤0.25 μg/L) and withholding or discontinuing antibiotics after a high PCT level (PCT > 0.25 μg/L). Results Antibiotic prescription patterns after the result of initial PCT level are summarized in Table 1. Only 242 patients (15%) had more than one PCT-level checked. Overall, antibiotic discordance with initial PCT result was 45%; mostly attributed to continuing or starting antibiotics despite a low PCT level (77%). (Figure 1) There were 496 patients who were initially started and continued on antibiotics despite a low PCT result. Of this subgroup, only one patient had a serial PCT measured, and 12 were admitted for Chronic Obstructive Pulmonary Disease (COPD) exacerbation and continued on azithromycin/doxycycline after result of the low PCT. Conclusion Utilization of antibiotics went against well-studied PCT cutoffs 45% of the time, primarily driven by antibiotic use at low PCT levels. Only a small number were continued on azithromycin/doxycycline for anti-inflammatory effect in COPD exacerbations, indicating that most patients received antibiotics for presumed bacterial infection despite the high negative predictive value of PCT. This study illustrates PCT use in real-world practice did not significantly alter prescribing practices, potentially from lack of confidence or knowledge in interpreting PCT results and lack of serial measurements to aid in decision-making. Disclosures All authors: No reported disclosures.

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The Status of African American Men in the New York City Construction Industry

Race, Markets, and Social Outcomes ◽

10.1007/978-1-4615-6157-6_2 ◽

1997 ◽

pp. 15-29 ◽

Cited By ~ 3

Author(s):

Timothy Bates ◽

David Howell

Keyword(s):

New York ◽

New York City ◽

African American ◽

Construction Industry ◽

York City ◽

African American Men ◽

The Status ◽

City Construction

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THE FURTHER SEPARATION OF TYPES AMONG THE PNEUMOCOCCI HITHERTO INCLUDED IN GROUP IV AND THE DEVELOPMENT OF THERAPEUTIC ANTISERA FOR THESE TYPES

Journal of Experimental Medicine ◽

10.1084/jem.55.4.531 ◽

1932 ◽

Vol 55 (4) ◽

pp. 531-554 ◽

Cited By ~ 44

Author(s):

Georgia Cooper ◽

Carolyn Rosenstein ◽

Annabel Walter ◽

Lenore Peizer

Keyword(s):

Clinical Trial ◽

New York ◽

New York City ◽

York City ◽

Respiratory Infections ◽

Group Iv ◽

Therapeutic Trial ◽

High Grade ◽

Normal Individuals ◽

Spinal Meningitis

The unclassified strains known as Group IV have been separated into twenty-nine types which are designated by the Roman numerals IV and XXXII. Only a small percentage of the pneumococcus strains isolated in New York City for this study were left unclassified. The majority of the types gave very slight cross-reactions, the exceptions being Types II and V, III and VIII, VII and XVIII and XV and XXX. In the series of cases studied, Types IV, V, VII and VIII were found more prevalent in the lobar pneumonia of adults and Types V, VI a and XIV in children. The majority of the types were also found in normal individuals and in persons having respiratory infections other than pneumonia. Types VI a and XIX were most prevalent in the limited number of strains studied by us. Fourteen of the types were found in pneumococcus meningitis; Type XVIII was found most often. Antisera suitable for clinical trial have been prepared for fourteen types. From the majority of the horses inoculated for more than a year, antisera having 500 to 1000 units per cc. were obtained. Antisera of lower potency were concentrated and preparations obtained equal to or stronger than high grade unconcentrated serum. Potent bivalent antisera have been prepared for types which were found to give marked cross-agglutination reactions. The results with each type as to prevalence, severity of cases, presence in normal individuals, and in spinal meningitis, potency of antisera produced for therapeutic trial and virulence of strains for mice have been considered under the different type headings.

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