#41: Examining the Role of Rurality on the Incidence of Acute Respiratory Illnesses, Overall Antibiotic Use and Inappropriate Antibiotic Use Among Young Children in Tennessee

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S12-S13
Author(s):  
K Dantuluri ◽  
J Bruce ◽  
K Edwards ◽  
L Howard ◽  
C Grijalva
Keyword(s):  
United States ◽  
Young Children ◽  
Low Income ◽  
Antibiotic Use ◽  
The United States ◽  
Antibiotic Prescribing ◽  
United States Census Bureau ◽  
Antibiotic Resistant ◽  
Respiratory Illnesses ◽  
Rural Counties

Abstract Background The Centers for Disease Control and Prevention (CDC) defines inappropriate antibiotic use as prescribing antibiotics not in accordance with national and local evidence-based guidelines, wrong selection of antibiotics, wrong dosing of antibiotics, or wrong duration of antibiotic use. Inappropriate antibiotic use has been associated with the development and transmission of antibiotic-resistant organisms. Acute respiratory illnesses (ARI) are the leading causes of antibiotic use among children with rates of antibiotic use in Tennessee children among the highest in the United States. The reasons for this have not been adequately assessed, particularly in children enrolled in the Tennessee Medicaid (TennCare) program, who tend to live in low-income households and rural locales and are disproportionately underrepresented in database studies conducted in large managed care organizations. We sought to examine whether the rates of ARI-related overall antibiotic use and inappropriate antibiotic use among young children enrolled in TennCare vary by the rurality of their county of residence. Methods This was a retrospective cohort study of children aged 2 months–5 years enrolled in TennCare from July 1, 2007, to June 30, 2017. We used pharmacy and healthcare claims data to calculate the incidence of ARI and ARI-related antibiotic use. Each eligible child entered into the cohort at the earliest time when selection criteria were met, and follow-up continued from cohort entry until the earliest of loss of enrollment, death, end of study, or meeting exclusion criteria. ARI was identified using International Classification of Diseases, Ninth and Tenth Revisions (ICD-9 and ICD-10) and ARI-related antibiotic use was defined as an antibiotic prescription filled within 72 hours of an ARI. ARI-related antibiotic use was classified as potentially appropriate or inappropriate using a previously published CDC classification system. The rurality of children’s county of residence was defined as either mostly urban, mostly rural, or completely rural based upon the United States Census Bureau definitions. We calculated incidence rates for ARI, ARI-related antibiotic use, and ARI-related inappropriate antibiotic use. To assess the effect of rurality of residence on these outcomes, we used multivariable mixed-effects Poisson regression. These analyses accounted for other factors including child age, gender, race, underlying comorbidities, calendar year and month, and history of antibiotic exposure. Results In total, 813,432 children met enrollment criteria and contributed a total of 2,057,272 person-years for the cohort. Overall, the rate of ARIs, antibiotic use associated with ARIs, and inappropriate antibiotic use associated with ARIs has trended down over time (Figure 1A). There were higher rates of these three outcomes in children who live in mostly rural and completely rural counties compared with those who live in mostly urban counties (Figure 1B–D). Conclusions Children who live in rural counties in Tennessee are disproportionately affected by higher rates of ARIs, antibiotic use, and inappropriate antibiotic use compared with those who live in urban counties. These findings can inform targeted stewardship interventions to reduce inappropriate antibiotic prescribing and to decrease the rates of antibiotic-resistant infections.

scholarly journals 1099. Antibiotic Prescriptions for Acute Gastroenteritis during Office and Emergency Department Visits–United States, 2006–2015

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S330-S330
Author(s):  
Jennifer P Collins ◽  
Louise Francois Watkins ◽  
Laura M King ◽  
Monina Bartoces ◽  
Katherine Fleming-Dutra ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Medical Care ◽  
Acute Gastroenteritis ◽  
Antibiotic Use ◽  
The United States ◽  
Emergency Department Visits ◽  
Antibiotic Prescribing ◽  
Care Survey ◽  
Ambulatory Medical Care

Abstract Background Acute gastroenteritis (AGE) is a major cause of office and emergency department (ED) visits in the United States. Most patients can be managed with supportive care alone, although some require antibiotics. Limiting unnecessary antibiotic use can minimize side effects and the development of resistance. We used national data to assess antibiotic prescribing for AGE to target areas for stewardship efforts. Methods We used the 2006–2015 National Hospital Ambulatory Medical Care Survey of EDs and National Ambulatory Medical Care Survey to describe antibiotic prescribing for AGE. An AGE visit was defined as one with a new problem (<3 months) as the main visit indication and an ICD-9 code for bacterial or viral gastrointestinal infection or AGE symptoms (nausea, vomiting, and/or diarrhea). We excluded visits with ICD-9 codes for Clostridium difficile or an infection usually requiring antibiotics (e.g., pneumonia). We calculated national annual percentage estimates based on weights of sampled visits and used an α level of 0.01, recommended for these data. Results Of the 12,191 sampled AGE visits, 13% (99% CI: 11–15%) resulted in antibiotic prescriptions, equating to an estimated 1.3 million AGE visits with antibiotic prescriptions annually. Antibiotics were more likely to be prescribed in office AGE visits (16%, 99% CI: 12–20%) compared with ED AGE visits (11%, 99% CI: 9–12%; P < 0.01). Among AGE visits with antibiotic prescriptions, the most frequently prescribed were fluoroquinolones (29%, 99% CI: 21–36%), metronidazole (18%, 99% CI: 13–24%), and penicillins (18%, 99% CI: 11–24%). Antibiotics were prescribed for 25% (99% CI: 8–42%) of visits for bacterial AGE, 16% (99% CI: 12–21%) for diarrhea without nausea or vomiting, and 11% (99% CI: 8–15%) for nausea, vomiting, or both without diarrhea. Among AGE visits with fever (T ≥ 100.9oF) at the visit, 21% (99% CI: 11–31%) resulted in antibiotic prescriptions. Conclusion Patients treated for AGE in office settings were significantly more likely to receive prescriptions for antibiotics compared with those seen in an ED, despite likely lower acuity. Antibiotic prescribing was also high for visits for nausea or vomiting, conditions that usually do not require antibiotics. Antimicrobial stewardship for AGE is needed, especially in office settings. Disclosures All authors: No reported disclosures.

scholarly journals Antibiotic Use and Resistance for Beef Cattle Producers

EDIS ◽  
2019 ◽  
Vol 2019 (1) ◽  
Author(s):  
Chad Carr ◽  
Matthew J. Hersom ◽  
K. C. Jeong ◽  
Nicolas DiLorenzo ◽  
Jason M. Scheffler ◽  
...  
Keyword(s):  
United States ◽  
Beef Cattle ◽  
Antibiotic Use ◽  
The United States ◽  
Cattle Production ◽  
Antibiotic Resistant ◽  
Fact Sheet ◽  
Animal Sciences

Antibiotic-resistant microorganisms cause millions of illnesses and cost billions of dollars in the United States each year. This 5-page fact sheet written by Chad Carr, Matt Hersom, K. C. Jeong, Nicolas DiLorenzo, Jason Scheffler, Victoria Roberts, Gina Faniola, Stephanie Miller, Haley Denney, Nahilia Williams, and Bianca McCracken and published by the UF/IFAS Department of Animal Sciences discusses the use of antibiotics in cattle production operations and answers some common questions about antibiotics and antibiotic-resistant microorganisms.  http://edis.ifas.ufl.edu/an351

scholarly journals Economic Evaluation of FebriDx®: A Novel Rapid, Point-of-Care Test for Differentiation of Viral versus Bacterial Acute Respiratory Infection in the United States

2021 ◽  
Vol 8 (2) ◽  
pp. 56-62
Author(s):  
Katherine Dick ◽  
John Schneider
Keyword(s):  
United States ◽  
Economic Evaluation ◽  
Antibiotic Treatment ◽  
Bacterial Infections ◽  
Point Of Care ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Point Of Care Testing ◽  
Antibiotic Resistant ◽  
Point Of Care Test

Background: Acute respiratory infections (ARIs) are commonly treated with antibiotics in outpatient settings, but many infections are caused by viruses and antibiotic treatment is therefore inappropriate. FebriDx®, a rapid point-of-care test that can differentiate viral from bacterial infections, can inform antibiotic treatment decisions. Objectives: The primary aim of this study is to conduct a literature-based US economic evaluation of a novel rapid point-of-care test, FebriDx®, that simultaneously measures two key infection biomarkers, C-reactive protein (CRP) and\ Myxovirus resistance protein A (MxA), to accurately differentiate viral from bacterial infection. Methods: A budget impact model was developed based on a review of published literature on antibiotic prescribing for ARIs in the United States. The model considers the cost of antibiotic treatment, antibiotic resistant infections, antibiotic-related adverse events, and point-of-care testing. These costs were extrapolated to estimate savings on a national level. Results: The expected national cost to treat ARIs under standard of care was US $8.25 billion, whereas the expected national cost of FebriDx point-of-care-guided ARI treatment was US $5.74 billion. Therefore, the expected national savings associated with FebriDx® rapid point-of-care testing was US $2.51 billion annually. Conclusions: FebriDx, a point of care test that can reliably aid in the differentiation of viral and bacterial infections, can reduce antibiotic misuse and, therefore, antibiotic resistant infections. This results in significant cost savings, driven primarily by the reduction in antibiotic resistant infections.

scholarly journals Diagnostic Testing and Antibiotic Use in Young Children With Community-Acquired Pneumonia in the United States, 2008–2015

2019 ◽  
Vol 9 (2) ◽  
pp. 248-252 ◽  
Author(s):  
Todd A Florin ◽  
Terri Byczkowski ◽  
Jeffrey S Gerber ◽  
Richard Ruddy ◽  
Nathan Kuppermann
Keyword(s):  
United States ◽  
Young Children ◽  
Blood Count ◽  
Complete Blood Count ◽  
Diagnostic Testing ◽  
Antibiotic Use ◽  
The United States ◽  
National Sample ◽  
Community Acquired Pneumonia ◽  
Over Time

Abstract Diagnostic testing and antibiotics are not routinely recommended for young children with community-acquired pneumonia. In a national sample of >6 million outpatient 1- to 6-year-olds with community-acquired pneumonia between 2008 and 2015, a complete blood count was obtained for 8.6% (95% confidence interval [CI], 6.1%–11.1%), radiography was performed for 43% (95% CI, 36%–50%), and antibiotics were given for 73.9% (95% CI, 67.1%–80.7%). There were no changes in testing or antibiotic use over time.

scholarly journals The Impact of Influenza Vaccination on Antibiotic Use in the United States, 2010–2017

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Eili Y Klein ◽  
Emily Schueller ◽  
Katie K Tseng ◽  
Daniel J Morgan ◽  
Ramanan Laxminarayan ◽  
...  
Keyword(s):  
United States ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
State Level ◽  
Population Level ◽  
Antibiotic Use ◽  
The United States ◽  
Vaccine Effectiveness ◽  
Severe Illness ◽  
Antibiotic Prescribing

Abstract Background Influenza, which peaks seasonally, is an important driver for antibiotic prescribing. Although influenza vaccination has been shown to reduce severe illness, evidence of the population-level effects of vaccination coverage on rates of antibiotic prescribing in the United States is lacking. Methods We conducted a retrospective analysis of influenza vaccination coverage and antibiotic prescribing rates from 2010 to 2017 across states in the United States, controlling for differences in health infrastructure and yearly vaccine effectiveness. Using data from IQVIA’s Xponent database and the US Centers for Disease Control and Prevention’s FluVaxView, we employed fixed-effects regression analysis to analyze the relationship between influenza vaccine coverage rates and the number of antibiotic prescriptions per 1000 residents from January to March of each year. Results We observed that, controlling for socioeconomic differences, access to health care, childcare centers, climate, vaccine effectiveness, and state-level differences, a 10–percentage point increase in the influenza vaccination rate was associated with a 6.5% decrease in antibiotic use, equivalent to 14.2 (95% CI, 6.0–22.4; P = .001) fewer antibiotic prescriptions per 1000 individuals. Increased vaccination coverage reduced prescribing rates the most in the pediatric population (0–18 years), by 15.2 (95% CI, 9.0–21.3; P < .001) or 6.0%, and the elderly (aged 65+), by 12.8 (95% CI, 6.5–19.2; P < .001) or 5.2%. Conclusions Increased influenza vaccination uptake at the population level is associated with state-level reductions in antibiotic use. Expanding influenza vaccination could be an important intervention to reduce unnecessary antibiotic prescribing.

scholarly journals 2742. The Impact of Influenza Vaccination on Antibiotic Use in the United States, 2010–2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S965-S966
Author(s):  
Eili Klein ◽  
Emily Schueller ◽  
Katie K Tseng ◽  
Arindam Nandi
Keyword(s):  
United States ◽  
Antibiotic Resistance ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Seasonal Influenza ◽  
Antibiotic Use ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Coverage Rates ◽  
The Impact

Abstract Background Antibiotic resistance is a cause of morbidity and mortality driven by inappropriate prescribing. In the United States, a third of all outpatient antibiotic prescriptions may be inappropriate. Seasonal influenza rates are significantly associated with antibiotic prescribing rates. The impact of influenza vaccination coverage on antibiotic prescribing is unknown. Methods We conducted a retrospective analysis of state-level vaccination coverage and antibiotic prescribing rates from 2010 to 2017. We used fixed effects regression to analyze the relationship between cumulative vaccine coverage rates for a season and the per capita number of prescriptions for systemic antibiotics for the corresponding season (January–March) controlling for temperature, poverty, healthcare infrastructure, population structure, and vaccine effectiveness. Results Rates of vaccination coverage ranged from 33% in Nevada to 52% in Rhode Island for the 2016–2017 season, while antibiotic use rates ranged from 25 prescriptions per 1,000 inhabitants in Alaska to 377 prescriptions per 1,000 inhabitants in West Virginia (Figure 1). Vaccination coverage rates were highly correlated with reduced prescribing rates, and controlling for other factors, we found that a one percent increase in the influenza vaccination rate was associated with 1.40 (95% CI: 2.22–0.57, P < 0.01) fewer antibiotic prescriptions per 1,000 inhabitants (Table 1). Increases in the vaccination coverage rate in the pediatric population (aged 0–18) had the strongest effect, followed by the elderly (aged 65+). Conclusion Vaccination can reduce morbidity and mortality from seasonal influenza. Though coverage rates are far below levels necessary to generate herd immunity, we found that higher coverage rates in a state were associated with lower antibiotic prescribing rates. While the effectiveness of the vaccine varies from year to year and the factors that drive antibiotic prescribing rates are multi-factorial, these results suggest that increased vaccination coverage for influenza would have significant benefit in terms of reducing antibiotic overuse and correspondingly antibiotic resistance. Disclosures All authors: No reported disclosures.

How We Fail Our Children Part II—Young Children from Poor and Low-Income Families

2020 ◽  
pp. 119-141
Author(s):  
Maxine Eichner
Keyword(s):  
United States ◽  
Young Children ◽  
Low Income ◽  
Family Policy ◽  
Free Market ◽  
The United States ◽  
First Year ◽  
Trade Off ◽  
Material Support ◽  
Low Income Families

Free-market family policy puts most American families in a difficult position when it comes to the trade-off between earning income to support a family and making sure young children get the caretaking that suits them best, but it clearly puts poor and low-income families in the toughest positions. This chapter considers the extent to which poor and low-income US families can privately provide the conditions that help young children thrive: adequate material support, a parent at home for up to the first year, good daycare and prekindergarten after that, and time with a nurturing parent. It also compares the likelihood that young children will receive this support in the United States under free-market family policy and in countries with pro-family policy.

Family context of low-income young children and their self-regulation in the United States and Turkey

2018 ◽  
Vol 190 (11) ◽  
pp. 1712-1724
Author(s):  
Mefharet Veziroglu-Celik ◽  
Aileen Garcia ◽  
Ibrahim H. Acar ◽  
Mubeccel Gonen ◽  
Helen Raikes ◽  
...  
Keyword(s):  
United States ◽  
Young Children ◽  
Low Income ◽  
Self Regulation ◽  
The United States ◽  
Family Context

Factors affecting the geographic variability of antibiotic-resistant healthcare-associated infections in the United States using the CDC Antibiotic Resistance Patient Safety Atlas

2019 ◽  
Vol 40 (05) ◽  
pp. 597-599 ◽  
Author(s):  
Julianne N. Kubes ◽  
Scott K. Fridkin
Keyword(s):  
United States ◽  
Escherichia Coli ◽  
Healthcare Facility ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Healthcare Associated Infections ◽  
Geographic Variability ◽  
Antibiotic Resistant ◽  
Factors Affecting ◽  
Healthcare Associated

AbstractWe utilized publicly available data from the Centers for Disease Control to explore possible causes of state-to-state variability in antibiotic-resistant healthcare-associated infections. Outpatient antibiotic prescribing rates of fluoroquinolones and cephalosporins explained some variability in extended-spectrum cephalosporin-resistant Escherichia coli after adjusting for differences in age and healthcare facility composition.

scholarly journals Are Census Omissions of Young Children Due to Respondent Misconceptions about the Census?

2020 ◽  
Vol 8 (6) ◽  
pp. 59
Author(s):  
Deborah H. Griffin ◽  
William P. O'Hare
Keyword(s):  
Young Child ◽  
Young Children ◽  
Low Income ◽  
Online Survey ◽  
The United States ◽  
Census Bureau ◽  
Census Count ◽  
United States Census ◽  
United States Census Bureau ◽  
Using Data

The United States Census Bureau acknowledges the systematic undercount of young children in censuses and widely used surveys. Despite the growing body of research to understand the scope and characteristics of undercounted young children, little is known about likely causes. Missing from the research are efforts to talk with respondents about possible reasons for young child omissions. This study addresses that shortcoming using data from an online survey asking 800 respondents with young children several questions related to children and the census. The results indicate that many respondents have doubts about including young children in the census count for their household. Only 82 percent of low-income parents of young children responded that they would include their young child in the census count for their household. This percentage was lower if children had weaker ties to a household. These survey results provide evidence that misconceptions and confusion about including young children in the census exist and could easily result in young child omissions. These findings warrant replication and suggest that significant changes in instructions are needed to dispel these respondent misconceptions.

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