Outpatient antibiotic prescribing and demographic factors associated with state-level septicemia mortality rates in US adults

AbstractBackgroundRates of septicemia/sepsis mortality and hospitalization in the US have risen significantly during the recent years, and antibiotic use may contribute to those rates through various mechanisms.MethodsWe used multivariable linear regression to relate state-specific rates of outpatient prescribing overall for fluoroquinolones, penicillins, macrolides, and cephalosporins between 2013-2014 to state-specific rates of septicemia mortality (ICD-10 codes A40-41 present as either the underlying or contributing causes of death) in each of the following age groups of adults: (18-49y, 50-64y, 65-74y, 75-84y, 85+y) between 2013-2014, adjusting for median household income, average annual temperature, age-specific percentages of state residents who (i) lived below the poverty level, (ii) were African American, (iii) lacked health insurance (in non-elderly age groups), and random effects associated with the different US Health and Human Services (HHS) regions.ResultsRates of penicillin prescribing were positively associated with septicemia mortality rates in the analyses for persons aged 65-74y, 75-84y and over 85y. Rates of cephalosporin prescribing were positively associated with septicemia mortality rates in the analyses for persons aged 18-49y and 65-74y. Rates of fluoroquinolone prescribing were positively associated with septicemia mortality rates in the analyses for persons aged 18-49y. Percent African Americans in a given age group was positively associated with septicemia mortality rates in the analyses for age groups over 65y, and 18-49y. Percent of residents in a given age group living below the poverty level was positively associated with septicemia mortality rates in the analysis for persons aged 65-74y.ConclusionsOur results suggest that rates of penicillin prescribing are associated with rates of septicemia mortality in older US adults, while rates of cephalosporin prescribing are associated with rates of septicemia mortality in persons aged 18-49y and 65-74y, and rates of fluoroquinolone prescribing are associated with rates of septicemia mortality in persons aged 18-49y. Further studies are needed to better understand the potential effect of antibiotic replacement in the treatment of different syndromes, such as replacement of fluoroquinolones by other antibiotics, possibly penicillins and cephalosporins following the recent US FDA guidelines on restriction of fluoroquinolone use, on the rates of sepsis mortality.

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Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states

10.1101/404137 ◽

2018 ◽

Cited By ~ 2

Author(s):

Edward Goldstein ◽

Derek R. MacFadden ◽

Zeynal Karaca ◽

Claudia A. Steiner ◽

Cecile Viboud ◽

...

Keyword(s):

Antibiotic Resistance ◽

Bacterial Infections ◽

Age Groups ◽

Antibiotic Use ◽

Mortality Rates ◽

Limited Information ◽

Sepsis Mortality ◽

Icd 10 ◽

Positive Correlations ◽

Tract Infections

AbstractObjectivesRates of hospitalization with sepsis/septicemia and associated mortality in the US have risen significantly during the last two decades. Antibiotic resistance may contribute to the rates of sepsis-related outcomes through lack of clearance of bacterial infections following antibiotic treatment during different stages of infection. However, there is limited information about the relation between prevalence of resistance to various antibiotics in different bacteria and rates of sepsis-related outcomes.MethodsFor different age groups of adults (18-49y,50-64y,65-74y,75-84y,85+y) and combinations of antibiotics/bacteria, we evaluated associations between state-specific prevalence (percentage) of resistant samples for a given combination of antibiotics/bacteria among catheter-associated urinary tract infections in the CDC Antibiotic Resistance Patient Safety Atlas data between 2011-2014 and rates of hospitalization with septicemia (ICD-9 codes 038.xx present on the discharge diagnosis) reported to the Healthcare Cost and Utilization Project (HCUP), as well as rates of mortality with sepsis (ICD-10 codes A40-41.xx present on death certificate).ResultsAmong the different combinations of antibiotics/bacteria, prevalence of resistance to fluoroquinolones in E. coli had the strongest association with septicemia hospitalization rates for individuals aged over 50y, and with sepsis mortality rates for individuals aged 18-84y. A number of positive correlations between prevalence of resistance for different combinations of antibiotics/bacteria and septicemia hospitalization/sepsis mortality rates in adults were also found.ConclusionsOur findings, as well as our related work on the relation between antibiotic use and sepsis rates support the association between resistance to/use of certain antibiotics and rates of sepsis-related outcomes, suggesting the potential utility of antibiotic replacement.

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Prescribing of different antibiotics, rates of sepsis-related mortality and bacteremia in the US and England, and the utility of antibiotic replacement vs. reduction in prescribing: a cross-sectional study

10.21203/rs.2.10944/v1 ◽

2019 ◽

Cited By ~ 1

Author(s):

Edward Goldstein

Keyword(s):

Bacterial Infections ◽

Multivariable Analysis ◽

Age Groups ◽

Epidemiological Data ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Limited Information ◽

Cross Sectional ◽

E Coli ◽

The Us

Abstract Background Antibiotic 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 on the rates of outcomes related to severe bacterial infections. Methods We looked at associations between the proportions (state-specific in the US; Clinical Commissioning Group (CCG)-specific in England) of different antibiotic types/classes among all prescribed antibiotics in the outpatient setting (oral antibiotics in the US), and rates of outcomes (mortality with sepsis, ICD-10 codes A40-41 present as either underlying or contributing causes of death on a death certificate in different age groups of US adults; E. coli as well as MSSA bacteremia in England) per unit of antibiotic prescribing (defined as the rate of outcome divided by the rate of outpatient prescribing of all antibiotics). Results In the US, prescribing of penicillins was associated with rates of mortality with sepsis for persons aged 75-84y and 85+y between 2014-2015. In England, prescribing of penicillins other than amoxicillin/co-amoxiclav was associated with rates of both MSSA and E. coli bacteremia for the period between financial years 2014/15 through 2017/18. Additionally, multivariable analysis for the US data has also shown 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 sepsis in the corresponding age groups. Conclusions Our results suggest that prescribing of penicillins is associated with rates of E. coli and MSSA bacteremia in England, and rates of mortality with sepsis in older US adults. Those results, as well as the related epidemiological data suggest that replacement of certain antibiotics, particularly penicillins in the treatment of certain syndromes should be considered for reducing the rates of outcomes related to severe bacterial infections.

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Age, time and cohort factors in mortality from cancer of the cervix

Journal of Hygiene ◽

10.1017/s0022172400022725 ◽

1973 ◽

Vol 71 (2) ◽

pp. 253-259 ◽

Cited By ~ 29

Author(s):

J. C. Barrett

Keyword(s):

Age Groups ◽

Mortality Rates ◽

Age Group ◽

Mortality Pattern ◽

England And Wales ◽

Cancer Of The Cervix

SUMMARYData for mortality from cancer of the cervix in England and Wales by 5-year age groups and four quinquennia (1951–70) are analysed. The logarithms of the mortality rates are regressed on age group, epoch of death and epoch of birth. The factors obtained are considered in relation to particular features of the mortality pattern, such as the reversal of trend in certain age groups.

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Impact of the COVID-19 pandemic on community antibiotic prescribing in Scotland

JAC-Antimicrobial Resistance ◽

10.1093/jacamr/dlaa105 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

William Malcolm ◽

Ronald A Seaton ◽

Gail Haddock ◽

Linsey Baxter ◽

Sarah Thirlwell ◽

...

Keyword(s):

Respiratory Infections ◽

Age Groups ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Prescription Data ◽

National Data ◽

Time Data ◽

Electronic Messaging ◽

The Impact ◽

Selection Of

Abstract Background Following concerns about increased antibiotic use during the COVID-19 pandemic, trends in community antibiotic prescriptions in Scotland were evaluated. Methods The primary care prescription electronic messaging system used in GP practices with NHS contracts provided near real-time data analysis of national data. The main outcome measures were the weekly number of prescriptions for antibiotics generated by prescribers in GP practices in 2020 compared with 2019. Results At end of Week 12 2020 (22 March), after a sharp increase, the number of prescriptions commonly used for respiratory infections was 44% higher than the corresponding week in 2019. The number of prescriptions for respiratory antibiotics reduced through April and May 2020, with 34% fewer prescriptions issued by end of Week 22 (31 May) than in the corresponding week in 2019. Reductions were pronounced in all age groups but particularly apparent for prescriptions for children aged 0–4 years. These data were compared with weekly prescriptions for a selection of non-respiratory antibiotics and no difference was seen between 2020 and 2019. Conclusions Trends in antibiotic prescription data show that after an initial surge, and following ‘lockdown’ in Scotland, the total number of prescriptions for antibiotics commonly used for respiratory infections fell. We believe this is the first published national evaluation of the impact of COVID-19 on community use of antibiotics. Further analysis of national data is planned to provide a greater understanding of the reasons behind these trends.

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Mortality from idiopathic pulmonary fibrosis: a temporal trend analysis in Brazil, 1979-2014

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562017000000035 ◽

2017 ◽

Vol 43 (6) ◽

pp. 445-450 ◽

Cited By ~ 5

Author(s):

Eduardo Algranti ◽

Cézar Akiyoshi Saito ◽

Diego Rodrigues Mendonça e Silva ◽

Ana Paula Scalia Carneiro ◽

Marco Antonio Bussacos

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Temporal Trend ◽

Population Aging ◽

Age Groups ◽

International Classification Of Diseases ◽

Mortality Rates ◽

Age Group ◽

Classification Of Diseases ◽

And Gender

ABSTRACT Objective: To analyze mortality from idiopathic pulmonary fibrosis (IPF) in Brazil over the period 1979-2014. Methods: Microdata were extracted from the Brazilian National Ministry of Health Mortality Database. Only deaths for which the underlying cause was coded as International Classification of Diseases version 9 (ICD-9) 515 or 516.3 (until 1995) or as ICD version 10 (ICD-10) J84.1 (from 1996 onward) were included in our analysis. Standardized mortality rates were calculated for the 2010 Brazilian population. The annual trend in mortality rates was analyzed by joinpoint regression. We calculated risk ratios (RRs) by age group, time period of death, and gender, using a person-years denominator. Results: A total of 32,092 deaths were recorded in the study period. Standardized mortality rates trended upward, rising from 0.24/100,000 population in 1979 to 1.10/100,000 population in 2014. The annual upward trend in mortality rates had two inflection points, in 1992 and 2008, separating three distinct time segments with an annual growth of 2.2%, 6.8%, and 2.4%, respectively. The comparison of RRs for the age groups, using the 50- to 54-year age group as a reference, and for the study period, using 1979-1984 as a reference, were 16.14 (14.44-16.36) and 6.71 (6.34-7.12), respectively. Men compared with women had higher standardized mortality rates (per 100,000 person-years) in all age groups. Conclusion: Brazilian IPF mortality rates are lower than those of other countries, suggesting underdiagnosis or underreporting. The temporal trend is similar to those reported in the literature and is not explained solely by population aging.

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Outpatient prescribing of four major antibiotic classes and prevalence of antimicrobial resistance in US adults

10.1101/456244 ◽

2018 ◽

Cited By ~ 2

Author(s):

Edward Goldstein ◽

Derek R. MacFadden ◽

Robyn S. Lee ◽

Marc Lipsitch

Keyword(s):

Antibiotic Resistance ◽

Age Groups ◽

Antibiotic Use ◽

Fluoroquinolone Resistance ◽

Limited Information ◽

E Coli ◽

Atlas Data ◽

Average Annual Temperature ◽

The Us ◽

Tract Infections

AbstractBackgroundThere is limited information on the relation between antibiotic use and antibiotic resistance in the US.MethodsWe used multivariable logistic regression to relate state-specific rates of outpatient prescribing overall for fluoroquinolones, penicillins, macrolides, and cephalosporins between 2011-2014 to state-specific prevalence of resistance for select combinations of antibiotics/bacteria among catheter-associated urinary tract infections (CAUTIs) in the CDC Patient Safety Atlas data between 2011-2014 for adults aged 65+y and 19-64y, adjusting for potential confounders.ResultsRates of fluoroquinolone prescribing were positively associated with prevalence of fluoroquinolone resistance in Escherichia coli and Pseudomonas aeruginosa (both age groups), resistance to extended-spectrum (ES) cephalosporins in E. coli (aged 19-64y), and resistance to methicillin in Staphylococcus aureus (aged 19-64y). Rates of penicillin prescribing were positively associated with prevalence of resistance to fluoroquinolones in E. coli (aged 65+) and P. aeruginosa (both age groups), and resistance to ES cephalosporins in Klebsiella spp. (both age groups). Rates of cephalosporin prescribing were negatively associated with prevalence of resistance to fluoroquinolones in E. coli and resistance to ES cephalosporins in Klebsiella spp. (both age groups). Average annual temperature was positively associated with prevalence of resistance to ES cephalosporins in E. coli and P. aeruginosa, and resistance to fluoroquinolones in E. coli.ConclusionsOur results suggest that prescribing of fluoroquinolones and penicillins to US adults is associated with prevalence of antibiotic resistance, including ESBLs and MRSA. Further work is needed to understand the potential benefit of replacing fluoroquinolones and penicillins by other antibiotics for reducing prevalence of antibiotic resistance.

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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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A five years retrospective study of factors influencing outcome of major lower limb amputations

International Surgery Journal ◽

10.18203/2349-2902.isj20203234 ◽

2020 ◽

Vol 7 (8) ◽

pp. 2553

Author(s):

Sudhir Marahanumaiah ◽

Sridhar Govindaiah

Keyword(s):

Lower Extremity ◽

Lower Limb ◽

Mortality Rates ◽

Age Group ◽

Peripheral Vascular ◽

Elderly Age ◽

Mortality And Morbidity ◽

Factors Associated ◽

Tertiary Centre ◽

Male Patients

Background: The word amputation is derived from Latin -Amputare - to cut away. The amputation is indicated when the limb is considered as dead limb/ deadly limb/ dead loss limb. Often cases are referred to tertiary centre late, resulting in complications which requires surgical management. Aim of the study was to compare the outcomes of major lower limb amputations and to identify risk factors associated with mortality and morbidity following major lower limb amputations.Methods: A retrospective observational study was done for 5 years between January 2014 to November 2019, comprising 276 patients undergoing major lower extremity amputations. Adult patients undergoing lower extremity amputations for ischemic, infected or gangrenous lower limb were included and patients who underwent amputations for trauma or tumours were excluded. The data regarding comorbidities, postoperative complications, outcome of major lower limb amputations were evaluated.Results: 276 patients underwent lower limb amputations (above knee amputations (AKA)-127, below knee amputations (BKA)-134, forefoot amputations-15). Male patients outnumbered females (6.7:1) and most of them were of elderly age group (mean age 60.56 years). The most common indications for amputations in our study were peripheral vascular disease (120), diabetes (87), necrotizing fasciitis (37). The 1 year mortality rates following lower limb amputations in our study were 14% (BKA) and 34% (AKA).Conclusions: Lower limb amputations are associated with high mortality rates. Mortality can be expected in both the early and the late postoperative periods and is most probably related to serious comorbidities, such as renal and heart disease, rather than the level of amputation.

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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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Nasopharyngeal Meningococcal Carriage among Children and Adolescents in Turkey in 2018: An Unexpected High Serogroup X Carriage

Children ◽

10.3390/children8100871 ◽

2021 ◽

Vol 8 (10) ◽

pp. 871

Author(s):

Mahmut Can Kizil ◽

Omer Kilic ◽

Mehmet Ceyhan ◽

Merve Iseri Nepesov ◽

Adem Karbuz ◽

...

Keyword(s):

Children And Adolescents ◽

Control Strategies ◽

Age Groups ◽

Antibiotic Use ◽

Age Group ◽

Upper Respiratory Tract ◽

Carriage Rate ◽

Significant Difference ◽

Tract Infections ◽

The Impact

Meningococcal carriage studies and transmission modeling can predict IMD epidemiology and used to define invasive meningococcal disease (IMD) control strategies. In this multicenter study, we aimed to evaluate the prevalence of nasopharyngeal Neisseria meningitidis (Nm) carriage, serogroup distribution, and related risk factors in Turkey. Nasopharyngeal samples were collected from a total of 1267 children and adolescents and were tested with rt-PCR. Nm carriage was detected in 96 participants (7.5%, 95% CI 6.1–9.0), with the peak age at 13 years (12.5%). Regarding age groups, Nm carriage rate was 7% in the 0–5 age group, was 6.9%in the 6–10 age group, was 7.9% in the 11–14 age group, and was 9.3% in the 15–18 age group. There was no statistically significant difference between the groups (p > 0.05). The serogroup distribution was as follows: 25% MenX, 9.4% MenA, 9.4% MenB, 2.1% MenC, 3.1% MenW, 2.1% for MenY, and 48.9% for non-groupable. The Nm carriage rate was higher in children with previous upper respiratory tract infections and with a high number of household members, whereas it was lower in children with antibiotic use in the last month (p < 0.05 for all). In this study, MenX is the predominant carriage strain. The geographical distribution of Nm strains varies, but serogroup distribution in the same country might change in a matter of years. Adequate surveillance and/or a proper carriage study is paramount for accurate/dynamic serogroup distribution and the impact of the proposed vaccination.

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