scholarly journals 18. Durations of Antibiotic Therapy and Factors Associated with Longer Than Recommended Durations for Common Ambulatory Infections in an Integrated Healthcare System

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S10-S10
Author(s):  
Axel Vazquez Deida ◽  
Katherine C Shihadeh ◽  
Deborah Aragon ◽  
Bryan C Knepper ◽  
Timothy C Jenkins
Keyword(s):  
Family Medicine ◽  
Antibiotic Therapy ◽  
Ambulatory Care ◽  
Healthcare System ◽  
Group Analysis ◽  
Urgent Care ◽  
Integrated Healthcare ◽  
Factors Associated ◽  
Duration Of Therapy ◽  
Medicine Clinic

Abstract Background Duration of antibiotic therapy is an important focus for antibiotic stewardship, but the extent and drivers of excessive durations are not well understood. This project aimed to describe durations of therapy prescribed for common infections across the ambulatory care settings of an integrated healthcare system and identify factors associated with longer than recommended durations. Methods This was a retrospective, cross-sectional evaluation conducted from July 1, 2018 to June 30, 2019. We identified antibiotic prescriptions for adults age 18 years or older presenting to a Denver Health ambulatory care facility (urgent care, emergency department, family medicine clinic, or internal medicine clinic) for an infection with a recommended duration of therapy of 5 days or less based on institutional guidance. Infections included purulent and non-purulent cellulitis, uncomplicated subcutaneous abscess, acute bacterial sinusitis (ABS), acute otitis media (AOM), community acquired pneumonia, cystitis, and pyelonephritis treated with an indicated fluoroquinolone. Prescriptions for more than 5 days were classified as longer than recommended. We evaluated whether the following factors were associated with longer than recommended prescriptions: location of visit, type of infection, patients’ age, race/ethnicity, sex, infection type, and prescribing provider type Results 5331 prescriptions met inclusion criteria. Of those, the duration of therapy was longer than recommended for 2095 (39%) (Table 1). Durations varied significantly across locations (p< 0.0001). In the sub-group analysis family medicine clinics had the highest proportion of longer than recommended durations (46%). Durations also varied significantly by type of infection. For cellulitis, ABS, and AOM, the duration was longer than recommended in 50%, 54%, and 75% of cases, respectively. Other factors associated with longer than recommended durations included male sex (p< 0.0001) and prescriptions by advanced practice providers (p = 0.0008). Table 1: Antibiotic Duration of Therapy for Common Outpatient Infections Conclusion Care locations, infection types, and both patient and prescriber factors were associated with longer than recommended prescriptions suggesting specific opportunities to prevent excessive durations of therapy. Disclosures All Authors: No reported disclosures

scholarly journals Factors Associated with Longer than Recommended Durations of Antibiotic Therapy for Uncomplicated Ambulatory Infections in an Integrated Healthcare System

2021 ◽  
Author(s):  
Axel A Vazquez Deida ◽  
Katherine C Shihadeh ◽  
Deborah Aragon ◽  
Bryan C Knepper ◽  
Timothy C Jenkins
Keyword(s):  
Logistic Regression ◽  
Antibiotic Therapy ◽  
Ambulatory Care ◽  
Healthcare System ◽  
Integrated Healthcare ◽  
Care Network ◽  
Factors Associated

Abstract Across the ambulatory care network of an integrated healthcare system, durations of antibiotic therapy prescribed for uncomplicated infections were longer than recommended in 39% of cases. By logistic regression, site of care, prescriber characteristics, and type of infection were independently associated with longer than recommended durations of therapy.

scholarly journals 1007. A novel approach to evaluate antibiotic utilization across the spectrum of inpatient and ambulatory care and implications for prioritization of antibiotic stewardship efforts

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S354-S354
Author(s):  
Holly M Frost ◽  
Bryan C Knepper ◽  
Katherine C Shihadeh ◽  
Timothy C Jenkins
Keyword(s):  
Ambulatory Care ◽  
Healthcare System ◽  
Antibiotic Stewardship ◽  
Antibacterial Agent ◽  
Antibiotic Use ◽  
Urgent Care ◽  
Outpatient Clinics ◽  
Integrated Healthcare ◽  
Adult Outpatient ◽  
Systemic Antibacterial

Abstract Background Antibiotic overuse remains a significant problem in inpatient and outpatient settings. The objective of this study was to develop a methodology to evaluate antibiotic use across inpatient and ambulatory care sites in an integrated healthcare system in order to prioritize antibiotic stewardship efforts. Methods We conducted an epidemiologic study of antibiotic use across an integrated healthcare system on 12 randomly-selected days between October 1, 2017 and September 30, 2018. Inpatients and perioperative patients were recorded as having received an antibiotic if they were administered ≥1 dose of a systemic antibacterial agent. Outpatients were recorded as having received an antibiotic if they were prescribed ≥1 systemic antibacterial agent. Results On the study days, 10.9% (95% CI 10.6–11.3%) of patients received an antibiotic. Of all antibiotics administered or prescribed, 54.1% were from ambulatory care (95% CI 52.6–55.7%), 38.0% were from the hospital, (95% CI 36.6–39.5%), and 7.8% (95% CI 7.1–7.8%) were perioperative. The emergency department/urgent care centers, adult outpatient clinics, and adult noncritical care inpatient wards accounted for 26.4% (95% CI: 25.0–27.7%), 23.8% (95% CI: 22.6–25.2), and 23.9% (95% CI 22.7–25.3) of antibiotic use, respectively. Only 9.2% (95% CI: 8.3–10.1%) of all antibiotics were administered in critical care units. Antibiotics with a broad spectrum of Gram-negative activity accounted for 30.4% (95% CI: 29.0–31.9%) of all antibiotics prescribed. Infections of the respiratory tract were the leading indication for antibiotic use. Conclusion In an integrated healthcare system, nearly three-quarters of antibiotic use occurred in the emergency department/urgent care centers, adult outpatient clinics, and adult noncritical care inpatient wards. Antibiotics with a broad spectrum of Gram-negative activity accounted for a large portion of antibiotic use. Analysis of antibiotic utilization across the spectrum of inpatient and ambulatory care is useful to prioritize antibiotic stewardship efforts. Disclosures All authors: No reported disclosures.

A Novel Approach to Evaluate Antibiotic Utilization Across the Spectrum of Inpatient and Ambulatory Care and Implications for Prioritization of Antibiotic Stewardship Efforts

2019 ◽  
Vol 70 (8) ◽  
pp. 1675-1682 ◽  
Author(s):  
Holly M Frost ◽  
Bryan C Knepper ◽  
Katherine C Shihadeh ◽  
Timothy C Jenkins
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Ambulatory Care ◽  
Healthcare System ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Urgent Care ◽  
Outpatient Clinics ◽  
Integrated Healthcare ◽  
Gram Negative

Abstract Background Antibiotic overuse remains a significant problem. The objective of this study was to develop a methodology to evaluate antibiotic use across inpatient and ambulatory care sites in an integrated healthcare system to prioritize antibiotic stewardship efforts. Methods We conducted an epidemiologic study of antibiotic use across an integrated healthcare system on 12 randomly selected days from 2017 to 2018. For inpatients and perioperative patients, administrations of antibiotics were recorded, whereas prescriptions were recorded for outpatients. Results On the study days, 10.9% (95% confidence interval [CI], 10.6%–11.3%) of patients received antibiotics. Of all antibiotics, 54.1% were from ambulatory care (95% CI, 52.6%–55.7%), 38.0% were from the hospital (95% CI, 36.6%–39.5%), and 7.8% (95% CI, 7.1%–8.7%) were perioperative. The emergency department/urgent care centers, adult outpatient clinics, and adult non–critical care inpatient wards accounted for 26.4% (95% CI, 25.0%–27.7%), 23.8% (95% CI, 22.6%–25.2%), and 23.9% (95% CI, 22.7%–25.3%) of antibiotic use, respectively. Only 9.2% (95% CI, 8.3%–10.1%) of all antibiotics were administered in critical care units. Antibiotics with a broad spectrum of gram-negative activity accounted for 30.4% (95% CI, 29.0%–31.9%) of antibiotics. Infections of the respiratory tract were the leading indication for antibiotics. Conclusions In an integrated healthcare system, more than half of antibiotic use occurred in the emergency department/urgent care centers and outpatient clinics. Antibiotics with a broad spectrum of gram-negative activity accounted for a large portion of antibiotic use. Analysis of antibiotic utilization across the spectrum of inpatient and ambulatory care is useful to prioritize antibiotic stewardship efforts.

scholarly journals 146. Predictors of Long Duration Antibiotic Therapy for Urinary Tract Infections and Community-Acquired Pneumonia in Pediatric Ambulatory Care Settings

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S185-S185
Author(s):  
Rohan M Shah ◽  
Shan Sun ◽  
Tonya Scardina ◽  
Sameer Patel
Keyword(s):  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Ambulatory Care ◽  
Community Acquired Pneumonia ◽  
Primary Language ◽  
Duration Of Therapy ◽  
Long Duration ◽  
Younger Age ◽  
Prolonged Duration ◽  
Tract Infections

Abstract Background Significant variation exists in the duration of antibiotic therapy for children in ambulatory care settings. Understanding drivers of variation for common conditions such as community-acquired pneumonia (CAP) and urinary tract infection (UTI) is important to informing antimicrobial stewardship interventions. Methods A retrospective observational study was conducted of patients with CAP and UTI seen in outpatient clinics or discharged from the emergency room (ER) of a tertiary care children’s hospital network from 2016 – 2019. Diagnoses CAP and UTI were identified via ICD-10 coding. Only oral medications ordered for ≥ 3 and < 28 days were included. Multivariable logistic regression was performed to identify predictors of long antibiotic duration (defined as ≥ 10 days). Potential non-clinical drivers of longer duration included race, ethnicity, sex, primary language, and insurance status. Results A total of 2,104 prescriptions for CAP from 442 prescribers and 1,070 prescriptions for UTI from 314 prescribers were included. Antibiotic durations were ≥ 10 days in 59.9% and 47.6% of prescriptions for CAP and UTI, respectively. Long duration of therapy was more common in children discharged from the ER when compared to clinics for both CAP (OR 1.795, 95% CI: 1.107 - 2.929), and UTI (OR 5.149, 95% CI: 1.933 - 16.373). The proportion of patients with long duration of therapy increased with younger age for both diagnoses and decreased overall in the final year of the study. Race, gender, ethnicity, and primary language were not associated with prolonged duration of therapy. However, patients with Medicaid insurance were more likely to receive long duration of therapy for CAP (OR 1.337, 95% CI: 1.062 - 1.682) and UTI (1.654, 95%, CI: 1.181 - 2.325). Conclusion In pediatric patients in ambulatory care settings, younger age, care in the ER, and being insured through Medicaid were independently associated with prolonged duration of therapy for both UTI and CAP. Disclosures All Authors: No reported disclosures

scholarly journals 115. Variable Use of Diagnostic Codes for Acute Respiratory Infections Across Emergency Departments and Urgent Care Clinics in an Integrated Healthcare System: Implications for Accuracy of Antibiotic Stewardship Metrics

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S171-S172
Author(s):  
Daniel J Livorsi ◽  
Rajeshwari Nair ◽  
Michihiko Goto ◽  
Eli N Perencevich
Keyword(s):  
Healthcare System ◽  
Antibiotic Stewardship ◽  
Respiratory Infections ◽  
Urgent Care ◽  
Diagnostic Code ◽  
Acute Respiratory Infections ◽  
Integrated Healthcare ◽  
Diagnostic Codes ◽  
Facility Level ◽  
Tract Infections

Abstract Background Antibiotic stewardship initiatives can leverage metrics that make peer-peer comparisons. A commonly used metric measures how frequently a clinician prescribes antibiotics for acute respiratory infections (ARIs), as defined by diagnostic codes. However, it is unclear if clinicians differ in their use of ARI diagnostic codes. In this study, we evaluated differences in how frequently clinicians code for ARIs and factors that are associated with the use of ARI diagnostic codes in Emergency Department (ED) and Urgent Care (UC) visits across an integrated healthcare system. Methods We analyzed a retrospective cohort of all ED and UC patient-visits across 129 Veterans Affairs medical centers during 2016-2018. ARI visits were identified using ICD-10 codes for acute bronchitis, influenza, pharyngitis, sinusitis, and upper respiratory tract infections for clinicians with 100 or more visits. A generalized linear mixed model with a link logit function that accounted for clustering at the clinician and facility-level was used to calculate median odds ratios (OR) and to identify factors associated with increased likelihood of entering an ARI code. Results There were 6,016,499 patient-visits, and 519,389 (8.6%) were coded as an ARI (Table 1). The mean rate of ARI diagnoses across all visits was 8.9% (SD 2.5%) at the facility-level and 7.4% (SD 4.5%) at the clinician-level (Table 2). The median OR was 2.19 (95% CI 2.18, 2.22), suggesting there was between-clinician variation in coding for ARI diagnoses. Visits were significantly more likely to be coded as ARIs if seen by an advanced practice provider (OR=2.36, 95% CI 2.19, 2.54), if a fever was recorded (OR=4.20, 95% CI 4.18, 4.29), and if the visit occurred between December-March (OR=1.97, 95% CI 1.96, 1.98). Approximately 2/5th of the variability (41.4%) in assigning an ARI diagnostic code was explained by differences across individual clinicians. Conclusion There was substantial variability in how frequently ED and UC clinicians coded a visit as an ARI, and a large proportion of the variability was explained by differences across clinicians. Unmeasured factors could include different approaches to using diagnostic codes. ARI metrics based on diagnostic codes may need to account for differences in clinicians’ coding behavior. Disclosures All Authors: No reported disclosures

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