214. Antibiotic Use for Common Infections in British Columbia: A Review of Outpatient Prescribing from 2000 - 2018

Abstract Background Antimicrobial resistance continues to jeopardize the future of modern medicine; as 92% of all antibiotics are used in the community, it is imperative to parse outpatient prescribing. In British Columbia (BC), efforts to curb the use of these essential medications have included: stewardship campaigns, practitioner guidelines, and vaccine scheduling amendments. This study reviews the trends in antibiotic use over the past two decades to identify new targets for Provincial stewardship and intervention. Methods Antibiotic prescription information was extracted from PharmaNet, a centralized data system that links all pharmacies with prescriptions dispensed in the community setting. The Medical Service Plan records reimbursement claims submitted by physicians for services provided, including diagnostic codes. Antibiotic prescriptions were extracted from PharmaNet and then matched to the billing system using anonymized patient identifiers. Prescription rates were calculated, and trends were examined by major anatomical therapeutic chemical (ATC) classification. Results Our study included 3,564,258 individuals over an 18-year period, with a total of 26,108,576 antibiotic prescriptions issued, for common infections. Overall antibiotic utilization decreased 18% (from 228 to 187 prescriptions per 1000 population) over the course of the study period. This trend was reflected in both Beta-Lactam (-37%) and Macrolide (-50%) antibiotics; two of the most common classes prescribed in the outpatient setting. A significant outlier was the J01X class of Other Antibacterials, which increased by a staggering 218%, by 2018. Further analyses are currently underway to stratify these changes in magnitude by demographic variables to identify specific, new targets for stewardship. Rates of outpatient antibiotic prescriptions, for common infections, per 1000 population, by major ATC class, over time. Conclusion Outpatient antibiotic prescribing has decreased steadily since 2000. These promising results can be ascribed to the various Provincial initiatives to quell the misuse of these medications. However, many of the indications tied to these prescriptions do not warrant the use of antibiotics, and further analyses are necessary to evaluate prescribing quality to fully delineate the state of antibiotic use in BC. Next steps also include comparing BC rates with Ontario, another large province of Canada. Disclosures All Authors: No reported disclosures

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229. Hospitalists Antimicrobial Scorecard Improves Antibiotic Prescribing at a Community Teaching Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.273 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S116-S116

Author(s):

Julia Sessa ◽

Helen Jacoby ◽

Bruce Blain ◽

Lisa Avery

Keyword(s):

Patient Care ◽

Teaching Hospital ◽

Antimicrobial Stewardship ◽

Rank Order ◽

Antibiotic Use ◽

Outpatient Setting ◽

Antibiotic Prescribing ◽

Full Time ◽

Days Of Therapy ◽

The Impact

Abstract Background Measuring antimicrobial consumption data is a foundation of antimicrobial stewardship programs. There is data to support antimicrobial scorecard utilization to improve antibiotic use in the outpatient setting. There is a lack of data on the impact of an antimicrobial scorecard for hospitalists. Our objective was to improve antibiotic prescribing amongst the hospitalist service through the development of an antimicrobial scorecard. Methods Conducted in a 451-bed teaching hospital amongst 22 full time hospitalists. The antimicrobial scorecard for 2019 was distributed in two phases. In October 2019, baseline antibiotic prescribing data (January – September 2019) was distributed. In January 2020, a second scorecard was distributed (October – December 2019) to assess the impact of the scorecard. The scorecard distributed via e-mail to physicians included: Antibiotic days of therapy/1,000 patient care days (corrected for attending census), route of antibiotic prescribing (% intravenous (IV) vs % oral (PO)) and percentage of patients prescribed piperacillin-tazobactam (PT) for greater than 3 days. Hospitalists received their data in rank order amongst their peers. Along with the antimicrobial scorecard, recommendations from the antimicrobial stewardship team were included for hospitalists to improve their antibiotic prescribing for these initiatives. Hospitalists demographics (years of practice and gender) were collected. Descriptive statistics were utilized to analyze pre and post data. Results Sixteen (16) out of 22 (73%) hospitalists improved their antibiotic prescribing from pre- to post-scorecard (χ 2(1)=3.68, p = 0.055). The median antibiotic days of therapy/1,000 patient care days decreased from 661 pre-scorecard to 618 post-scorecard (p = 0.043). The median PT use greater than 3 days also decreased significantly, from 18% pre-scorecard to 11% post-scorecard (p = 0.0025). There was no change in % of IV antibiotic prescribing and no correlation between years of experience or gender to antibiotic prescribing. Conclusion Providing antimicrobial scorecards to our hospitalist service resulted in a significant decrease in antibiotic days of therapy/1,000 patient care days and PT prescribing beyond 3 days. Disclosures All Authors: No reported disclosures

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Antibiotic Prescribing for Adults Hospitalized in the Etiology of Pneumonia in the Community Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx088 ◽

2017 ◽

Vol 4 (2) ◽

Cited By ~ 6

Author(s):

Sara Tomczyk ◽

Seema Jain ◽

Anna M Bramley ◽

Wesley H Self ◽

Evan J Anderson ◽

...

Keyword(s):

Antibiotic Use ◽

Community Acquired Pneumonia ◽

Community Study ◽

Antibiotic Prescribing ◽

Beta Lactam ◽

First Line ◽

Factors Associated ◽

Admission Ward ◽

Healthcare Associated ◽

To Receive

Abstract Background Community-acquired pneumonia (CAP) 2007 guidelines from the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recommend a respiratory fluoroquinolone or beta-lactam plus macrolide as first-line antibiotics for adults hospitalized with CAP. Few studies have assessed guideline-concordant antibiotic use for patients hospitalized with CAP after the 2007 IDSA/ATS guidelines. We examine antibiotics prescribed and associated factors in adults hospitalized with CAP. Methods From January 2010 to June 2012, adults hospitalized with clinical and radiographic CAP were enrolled in a prospective Etiology of Pneumonia in the Community study across 5 US hospitals. Patients were interviewed using a standardized questionnaire, and medical charts were reviewed. Antibiotics prescribed were classified according to defined nonrecommended CAP antibiotics. We assessed factors associated with nonrecommended CAP antibiotics using logistic regression. Results Among enrollees, 1843 of 1874 (98%) ward and 440 of 446 (99%) ICU patients received ≥1 antibiotic ≤24 hours after admission. Ward patients were prescribed a respiratory fluoroquinolone alone (n = 613; 33%), or beta-lactam plus macrolide (n = 365; 19%), beta-lactam alone (n = 240; 13%), among other antibiotics, including vancomycin (n = 235; 13%) or piperacillin/tazobactam (n = 157; 8%) ≤24 hours after admission. Ward patients with known risk for healthcare-associated pneumonia (HCAP), recent outpatient antibiotic use, and in-hospital antibiotic use <6 hours after admission were significantly more likely to receive nonrecommended CAP antibiotics. Conclusions Although more than half of ward patients received antibiotics concordant with IDSA/ATS guidelines, a number received nonrecommended CAP antibiotics, including vancomycin and piperacillin/tazobactam; risk factors for HCAP, recent outpatient antibiotic, and rapid inpatient antibiotic use contributed to this. This hypothesis-generating descriptive epidemiology analysis could help inform antibiotic stewardship efforts, reinforces the need to harmonize guidelines for CAP and HCAP, and highlights the need for improved diagnostics to better equip clinicians.

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Outpatient Antibiotic Prescribing in Massachusetts, 2011–2015

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz169 ◽

2019 ◽

Vol 6 (5) ◽

Cited By ~ 8

Author(s):

R Monina Klevens ◽

Evan Caten ◽

Scott W Olesen ◽

Alfred DeMaria ◽

Scott Troppy ◽

...

Keyword(s):

Anatomical Therapeutic Chemical ◽

Local Population ◽

Antibiotic Use ◽

Population Based ◽

The State ◽

World Health ◽

Antibiotic Prescribing ◽

Census Tracts ◽

Outpatient Prescription ◽

Ongoing Surveillance

Abstract Background The objectives of this study were to develop methods to measure population-based outpatient antibiotic prescribing in Massachusetts and to describe the findings as a first step toward institution of ongoing surveillance. Methods We analyzed outpatient prescription claims from the Massachusetts All-Payers Claims Database from 2011 to 2015. We grouped claims for antibiotics according to the World Health Organization’s Anatomical Therapeutic Chemical Classification System using the National Library of Medicine’s RXNorm database. We grouped prescribers into 17 specialties. Antibiotic use rates were calculated, and simple frequencies were used to describe patterns. Results The overall annual rate of outpatient antibiotic use for individuals aged 0–64 years was 696 prescriptions per 1000 people. During 2015, 68% of people in Massachusetts had no antibiotic prescription, and 17% had only 1 prescription. There was dramatic variability in antibiotic use rates by census tract within the state (rates of penicillin use ranged from 31 to 265 prescriptions per 1000 people, macrolides from 28 to 333, cephalosporins from 8 to 89, quinolones from 13 to 118). Antibiotic use rates were generally lower in urban census tracts. From 2011 to 2015, there was a 17% decline in antibiotic prescribing, with the greatest decline for macrolides (28%). Conclusions There was variability in antibiotic prescribing within Massachusetts by age, sex, and antibiotic class. Variation in antibiotic use across census tracts within the state was similar to the variation in use across US states. Continued measurement and detailed local population rates of antibiotic use in Massachusetts will provide feedback for local prescribers.

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1117. A Retrospective Analysis of Paediatric Prescribing in British Columbia from 2013 to 2016

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.981 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S397-S397

Author(s):

Ariana Saatchi ◽

David M Patrick ◽

James McCormack ◽

Andrew Morris ◽

Fawziah Marra

Keyword(s):

British Columbia ◽

Anatomical Therapeutic Chemical ◽

Age Groups ◽

Geographic Location ◽

Pediatric Care ◽

Antibiotic Prescribing ◽

Prescription Database ◽

Prescription Data ◽

Upper Respiratory Tract ◽

Tract Infections

Abstract Background Antibiotic prescribing in pediatric care is highly prevalent. Often children are prescribed antibiotics for conditions that are commonly self-limiting and viral in etiology such as upper respiratory tract infections. The purpose of this study was to examine the scope of pediatric antibiotic prescribing in British Columbia from 2013 to 2016 and identify potential new provincial antimicrobial stewardship targets. Methods Antibiotic prescription data for children were extracted from a provincial prescription database, and linked to demographic files in order to obtain patient age, sex and geographic location. Prescription rates were then calculated, and trends were examined by major anatomical therapeutic chemical (ATC) classification. Results Our cohort included an average of 271,134 children per year and 1,767,652 antibiotic prescriptions. Over the 4 years, rates of antibiotic prescribing increased 4.5% (from 453 to 474 prescriptions per 1,000 population per year). The greatest increase, across all classes of antibiotics, was seen in children aged 0–2 years of age. By 2016, the greatest increase in prescribing, by class, was observed in J01X (e.g., nitrofurantoin, fosfomycin) with a 1360% increase for children aged 3–9. Across all ages, quinolones (J01M) increased 98%. Remaining classes, including β lactams (J01C), and macrolides (J01F), experienced modest reductions in the older age groups. Conclusion Past studies have illustrated decreasing or static rates of antibiotic prescribing in British Columbia. However, we have identified a paradoxical (4.5%) increase in pediatric antibiotic prescribing since 2013. Although it appears that provincial efforts have been successful in reducing the use of broad-spectrum penicillins (J01C), marked surges in the use of classes like tetracylines (J01A), quinolones (J01M), and other antibacterials (J01X) identify a new potential target for provincial stewardship. Disclosures All authors: No reported disclosures.

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Patient Knowledge and Experiences With Antibiotic Use and Delayed Antibiotic Prescribing in the Outpatient Setting

Journal of Pharmacy Practice ◽

10.1177/0897190019889427 ◽

2019 ◽

pp. 089719001988942 ◽

Cited By ~ 2

Author(s):

Mary Beth A. Seipel ◽

Emily S. Prohaska ◽

Janelle F. Ruisinger ◽

Brittany L. Melton

Keyword(s):

Antibiotic Stewardship ◽

General Public ◽

Community Pharmacists ◽

Antibiotic Use ◽

Outpatient Setting ◽

Antibiotic Prescribing ◽

Patient Knowledge ◽

Cross Sectional Survey ◽

Chi Square ◽

Cross Sectional

Background: Most antibiotic prescriptions originate in the outpatient setting and an estimated 30% are unnecessary. Pharmacists are well positioned to positively impact antibiotic prescribing habits; the role of the community pharmacist in outpatient antibiotic stewardship programs is not well defined. Objectives: The objectives of this study were to (1) assess the knowledge of the general public regarding appropriate antibiotic use, and (2) assess the experiences of the general public regarding delayed antibiotic prescriptions. Methods: A cross-sectional survey was administered at community pharmacies in Kansas from September 2018 to January 2019. Eligible individuals were older than 18 years and self-reported their ability to speak and read English. The 22-item survey collected demographics, knowledge regarding appropriate antibiotic use, and participant understanding and experiences of delayed antibiotic prescribing. Descriptive statistics assessed demographics and chi-square compared responses between demographics. Results: Of 347 surveys completed, respondents were mainly Caucasian (91.6%), female (58.2%), and aged 60 years or older (59.1%). Those with high school education or below were more likely to believe antibiotics kill viruses (43.1% vs 20.9%, respectively; p < 0.01) and that antibiotics work on most coughs and colds (31.4% vs 16.2%, respectively; p = 0.01). Delayed antibiotic prescriptions were more frequently offered to those who had received an antibiotic prescription in the last year compared to those who had not (36.1% vs 15%, p < 0.001). Conclusion: Gaps in patient knowledge about appropriate antibiotic use and delayed prescribing present an opportunity for community pharmacists to educate patients and become involved in outpatient antibiotic stewardship.

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Anthropogenic Activities and the Problem of Antibiotic Resistance in Latin America: A Water Issue

Water ◽

10.3390/w13192693 ◽

2021 ◽

Vol 13 (19) ◽

pp. 2693

Author(s):

Delfina C. Domínguez ◽

Luz María Chacón ◽

D’Janique Wallace

Keyword(s):

Antibiotic Resistance ◽

Latin America ◽

Antimicrobial Resistance ◽

Latin American ◽

Anthropogenic Activities ◽

Antibiotic Use ◽

Modern Medicine ◽

Resistant Bacteria ◽

Beta Lactam ◽

Water Ecosystems

Antibiotics revolutionized modern medicine and have been an excellent tool to fight infections. However, their overuse and misuse in different human activities such as health care, food production and agriculture has resulted in a global antimicrobial resistance crisis. Some regions such as Latin America present a more complex scenario because of the lack of resources, systematic studies and legislation to control the use of antimicrobials, thus increasing the spread of antibiotic resistance. This review aims to summarize the state of environmental antibiotic resistance in Latin America, focusing on water resources. Three databases were searched to identify publications on antimicrobial resistance and anthropogenic activities in relation to natural and artificial water ecosystems. We found that antibiotic resistant bacteria, mainly against beta lactam antibiotics, have been reported in several Latin American countries, and that resistant bacteria as well as resistant genes can be isolated from a wide variety of aquatic environments, including drinking, surface, irrigation, sea and wastewater. It is urgent to establish policies and regulations for antibiotic use to prevent the increase of multi-drug resistant microorganisms in the environment.

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Prescribing of different antibiotics, rates of bacteremia/septicemia and associated mortality in the US and England, and the utility of antibiotic replacement vs. reduction in prescribing

10.1101/527101 ◽

2019 ◽

Cited By ~ 3

Author(s):

Edward Goldstein

Keyword(s):

Bacterial Infections ◽

Age Groups ◽

Epidemiological Data ◽

Antibiotic Use ◽

Outpatient Setting ◽

Antibiotic Prescribing ◽

Limited Information ◽

E Coli ◽

The Us ◽

Icd 10

AbstractBackgroundAntibiotic use contributes to the rates of bacteremia, sepsis and associated mortality, particularly through lack of clearance of resistant infections following antibiotic treatment. At the same time, there is limited information on the effects of prescribing of some antibiotics vs. others, of antibiotic replacement and of reduction in prescribing on the rates of severe outcomes associated with bacterial infections.MethodsFor each of several antibiotic types/classes, we looked at associations (univariate, and multivariable for the US data) between the proportions (state-specific in the US, Clinical Commissioning Group (CCG)-specific in England) of a given antibiotic type/class among all prescribed antibiotics in the outpatient setting, and rates of outcomes (mortality with septicemia, ICD-10 codes A40-41 present on the death certificate in different age groups of adults in the US, and E. coli or MSSA bacteremia in England) per unit of antibiotic prescribing (defined as the rate of outcome divided by the rate of prescribing of all antibiotics).ResultsIn the US, prescribing of penicillins was positively associated with rates of mortality with septicemia for persons aged 75-84y and 85+y between 2014-2015, while multivariable analyses also suggest an association between the percent of individuals aged 50-64y lacking health insurance, as well as the percent of individuals aged 65-84y who are African-American and rates of mortality with septicemia. In England, prescribing of penicillins other than amoxicillin/co-amoxiclav was positively associated with rates of both MSSA and E. coli bacteremia for the period between financial years 2014/15 through 2017/18. Additionally, as time progressed, correlations between prescribing for both trimethoprim and co-amoxiclav and rates of bacteremia in England decreased, while correlations between amoxicillin prescribing and rates of bacteremia increased.ConclusionsOur results suggest that prescribing of penicillins is associated with rates of E. coli and MSSA bacteremia in England, and rates of mortality with septicemia in older US adults, which agrees with our earlier findings. Those results, as well as the related epidemiological data suggest that antibiotic replacement rather than reduction in prescribing may be the more effective mechanism for reducing the rates of severe bacterial infections.

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143. Antibiotic Use for Common Infections in British Columbia and Ontario: A Review of Outpatient Prescribing to Seniors from 2000 – 2018

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.345 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S184-S184

Author(s):

Ariana Saatchi ◽

Jennifer Reid ◽

Marcus Povitz ◽

Salimah Shariff ◽

Michael Silverman ◽

...

Keyword(s):

Older Adults ◽

Adverse Drug Events ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Tier 1 ◽

Prescription Rates ◽

Administrative Health Databases ◽

Tract Infections ◽

Outpatient Settings ◽

Common Infections

Abstract Background Antimicrobials remain among the most prescribed medications in Canada, with over 90% prescribed in outpatient settings. Older adults (aged ≥65 years) prescribed antimicrobials are particularly vulnerable to adverse drug events and antimicrobial resistance. This study compared annual rates of indication-associated, outpatient prescribing to seniors across two Canadian provinces. Methods All outpatient, oral antimicrobials dispensed to older adults (≥65 years) were identified from administrative health databases, from 2000 to 2018. Antimicrobials were limited to outpatient use only and linked to an indication using a 3-tiered diagnostic hierarchy. When possible, a record of dispensation was matched to a tier 1 indication (always require antibiotics) first. In the absence of a tier 1 indication, priority was given to tier 2 (sometimes require antibiotics), then 3 (never require antibiotics). Prescription rates were calculated per 1000 population, and trends were examined overall, by drug class, and patient demographics. Results Our study included over 18 million individuals (aged ≥65 years) with a total of 23,773,552 antibiotic prescriptions issued to seniors, for common infections. In both provinces, prescribing for tier 1 diagnoses increased over the study period (BC: 44%; ON: 28%). Urinary tract infections accounted for most prescriptions within this tier (ON: 89 prescriptions/1000, BC: 129 prescriptions/1000 population by 2018). Pneumonia-associated prescribing increased by roughly 10% in both provinces. In any given study year, for both provinces, tier 3 diagnosis was the most common reason for antibiotic use, accounting for 50% of all indication-associated antibiotic prescribing. As diagnoses within this tier do not warrant prescribing all antibiotics issued are therefore inappropriate prescriptions. Figure 1. Rates of indication-associated antibiotic use in Canadian seniors, from 2000 to 2018. Conclusion Elevated prescribing to seniors continues across Canadian outpatient settings. Antibiotic prescribing remains an issue of high concern with 50% of all antimicrobials prescribed to seniors, for common infections, used inappropriately. Disclosures All Authors: No reported disclosures

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Antibiotic Use Among Hospitalized Children and Neonates in China: Results From Quarterly Point Prevalence Surveys in 2019

Frontiers in Pharmacology ◽

10.3389/fphar.2021.601561 ◽

2021 ◽

Vol 12 ◽

Author(s):

Chu-ning Wang ◽

Jianning Tong ◽

Bin Yi ◽

Benedikt D. Huttner ◽

Yibing Cheng ◽

...

Keyword(s):

Anatomical Therapeutic Chemical ◽

Antibiotic Use ◽

Point Prevalence ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Hospitalized Children ◽

Prevalence Survey ◽

Common Diagnosis ◽

Tract Infections ◽

The Impact

Background: Antimicrobial resistance is a significant clinical problem in pediatric practice in China. Surveillance of antibiotic use is one of the cornerstones to assess the quality of antibiotic use and plan and assess the impact of antibiotic stewardship interventions.Methods: We carried out quarterly point prevalence surveys referring to WHO Methodology of Point Prevalence Survey in 16 Chinese general and children’s hospitals in 2019 to assess antibiotic use in pediatric inpatients based on the WHO AWaRe metrics and to detect potential problem areas. Data were retrieved via the hospital information systems on the second Monday of March, June, September and December. Antibiotic prescribing patterns were analyzed across and within diagnostic conditions and ward types according to WHO AWaRe metrics and Anatomical Therapeutic Chemical (ATC) Classification.Results: A total of 22,327 hospitalized children were sampled, of which 14,757 (66.1%) were prescribed ≥1 antibiotic. Among the 3,936 sampled neonates (≤1 month), 59.2% (n = 2,331) were prescribed ≥1 antibiotic. A high percentage of combination antibiotic therapy was observed in PICUs (78.5%), pediatric medical wards (68.1%) and surgical wards (65.2%). For hospitalized children prescribed ≥1 antibiotic, the most common diagnosis on admission were lower respiratory tract infections (43.2%, n = 6,379). WHO Watch group antibiotics accounted for 70.4% of prescriptions (n = 12,915). The most prescribed antibiotic ATC classes were third-generation cephalosporins (41.9%, n = 7,679), followed by penicillins/β-lactamase inhibitors (16.1%, n = 2,962), macrolides (12.1%, n = 2,214) and carbapenems (7.7%, n = 1,331).Conclusion: Based on these data, overuse of broad-spectrum Watch group antibiotics is common in Chinese pediatric inpatients. Specific interventions in the context of the national antimicrobial stewardship framework should aim to reduce the use of Watch antibiotics and routine surveillance of antibiotic use using WHO AWaRe metrics should be implemented.

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A gut reaction

University of Western Ontario Medical Journal ◽

10.5206/uwomj.v85i1.4200 ◽

2016 ◽

Vol 85 (1) ◽

pp. 5-7

Author(s):

Dalia Hasan ◽

Kristen Reilly

Keyword(s):

Bacterial Resistance ◽

Medical Literature ◽

Antibiotic Use ◽

Mortality Rates ◽

Modern Medicine ◽

Prescribing Patterns ◽

Current Evidence ◽

Antibiotic Prescribing ◽

Antibiotic Overuse ◽

Obesity And Diabetes

The development of antibiotics is one of the greatest advances of modern medicine. While antibiotics have dramatically improved morbidity and mortality rates worldwide, current evidence asserts that one should err on the side of caution when prescribing antibiotics. The medical literature is accumulating studies on alarming consequences of inappropriate antibiotic use. Due to antibiotic overexposure, a North American “hypervirulant” strain of Clostridium difficile has emerged causing more severe gastrointestinal manifestations than previous strains. More recently, antibiotic overuse has been associated with obesity and diabetes mellitus. Unnecessary antibiotic use has led to increasing rates of bacterial resistance rendering more antibiotics ineffective. We are currently on the brink of an era which could reverse all the progress made with the introduction of antibiotics. The salient health consequences of inappropriate antibiotic prescriptions and the threat of a postantibiotic era command attention to practical initiatives that improve antibiotic prescribing patterns.

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