Antibiotic Prescribing Patterns for Childhood infections in Ambulatory Settings in Jordan

Abstract Background Sepsis is the leading cause of morbidity and mortality in hospitals, accounting for 30% of deaths in the emergency department. In 2001, Rivers et al. found that early goal-directed therapy (EGDT) led to significant mortality benefits, which ultimately prompted United States Centers for Medicare and Medicaid Services (CMS) to mandate EGDT in hospitals through its implementation of sepsis core measures. CMS core measures are intended to facilitate the broad implementation of evidence-based treatment standards, and while voluntary, non-compliance is associated with negative consequences to both quality and financial metrics for participating hospitals. However, while quality measures are implemented to ultimately improve patient care, its effects on the healthcare system can also include negative unanticipated consequences. This study seeks to characterize the effect of the CMS sepsis core measure on sepsis identification, antimicrobial utilization, and nd specific prescribing patterns. Methods This is a retrospective cohort review of 175 randomly selected patients greater than and equal to 18 years of age with admitting diagnosis of sepsis, severe sepsis, and septic shock from January 2013 to December 2018. Medical charts were reviewed for relevant data. Results Comparing ED antibiotic prescribing patterns between pre-and post-Sepsis CMS Core Measures, there was no statistical difference in total antibiotics usage and the initiation of broad antibiotics. There was a decreased time to the first antibiotic, an increase in receiving Normal Saline boluses post-Sepsis CMS Core Measures. Conclusion 1. No significant changes were seen in ED antibiotic prescribing behaviors with regard to volume and spectrum 2. ED time to antibiotic administration was significantly faster after the implementation of CMS Core Measures. Also, there was a significant positive shift in time to fluid bolus, fluid selection, and fluid volume 3. Significantly decreased ICU length of stay after implementation of CMS Core Measures possibly associated with above behavior changes 4. No outcomes benefits (mortality, hospital length of stay) realized after implementation of CMS Core Measures Disclosures All Authors: No reported disclosures

1428. Lyme Disease Treatment in the United States: Prescribing Patterns from a Nationwide Commercial Insurance Database, 2016-2018

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1610 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S720-S720

Author(s):

Amy M Beeson ◽

Grace E Marx ◽

Amy M Schwartz ◽

Alison F Hinckley

Keyword(s):

United States ◽

Lyme Disease ◽

Standard Treatment ◽

Age Distribution ◽

Public Health Problem ◽

The United States ◽

Adverse Outcomes ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Low Incidence

Abstract Background Lyme disease (LD) is the most common vector-borne disease in the United States and is a significant public health problem. The use of non-standard antibiotic treatment regimens for LD has been associated with adverse effects; however, the overall landscape of treatment has not been described previously. We aimed to describe real-world antibiotic prescribing patterns for LD. Methods We performed a retrospective analysis of the MarketScan commercial claims database of outpatient encounters from 2016-2018 in the United States. We identified all individuals with a visit that included an LD diagnosis code and a prescription within 30 days of the visit for one or more of 12 antibiotics that may be prescribed for LD. We then categorized each individual as having received either standard or non-standard treatment during the two-year period. Standard treatment was defined as treatment with a first, second or third-line antibiotic for LD, for no longer than 30 days, and for no more than two episodes during the study period. Descriptive and multivariable analyses were performed to compare characteristics of people who received standard vs non-standard treatment for LD. Results A total of 84,769 prescriptions met criteria for inclusion, written for 45,926 unique patients. The mean duration of prescriptions was 21.4 days (SD 10.8). Most individuals (84.5%) treated for LD received standard treatment during the study period. Female gender (OR 1.5, p< 0.0001) and age 19-45 (p=0.0003) were significantly associated with being prescribed non-standard LD treatment. Treatment in low-incidence states (OR 2.2 compared to high-incidence states, p< 0.0001) and during non-summer months (OR 2.2, p< 0.0001) was more likely to be non-standard. Age distribution of patients receiving treatment for Lyme disease, by gender and age at first prescription Seasonality of standard versus non-standard treatment of Lyme disease Conclusion In this population of employed, young, and insured patients, young and middle-aged women were at the highest risk of receiving non-standard LD treatment. Treatments prescribed in states with low incidence of LD or during non-summer months were also more likely to be non-standard, a trend which likely reflects misdiagnosis or overtreatment of LD. Future studies are needed to further define prescriber and patient factors associated with non-standard LD treatment and related adverse outcomes. Disclosures All Authors: No reported disclosures

A Clinical Pharmacy-Oriented Drug Surveillance Network: Results of a Nationwide Antibiotic Utilization Review of Bacterial Pneumonia–1987

DICP ◽

10.1177/106002808902300213 ◽

1989 ◽

Vol 23 (2) ◽

pp. 162-170

Author(s):

Thaddeus H. Grasela ◽

Jerome J. Schentag ◽

Steven J. Boekenoogen ◽

Kenneth D. Crist ◽

William L. Lowes ◽

...

Keyword(s):

Bacterial Pneumonia ◽

Prescribing Patterns ◽

Oral Drug ◽

Utilization Review ◽

Antibiotic Prescribing ◽

Drug Surveillance ◽

Surveillance Network ◽

Gram Negative ◽

Days Of Therapy ◽

Culture Positive

One hundred eighteen pharmacists enrolled in the Drug Surveillance Network completed a survey of antibiotic prescribing patterns for bacterial infections. A total of 319 hospitalized patients being treated for suspected or documented bacterial pneumonia were monitored, and this paper summarizes the data collected on this specific subpopulation. Two hundred three patients (64 percent) were treated for community-acquired pneumonia and 116 patients (36 percent) were treated for nosocomial pneumonia. Seventy-three percent of the nosocomial pneumonias were culture-positive, with a gram-negative microorganism as the predominant isolate. Forty-eight percent of the community-acquired pneumonias were culture-positive with a mixture of gram-positive and gram-negative organisms. Fifty percent of patients were treated with a single agent, 33 percent with two antibiotics, and the remaining 17 percent with a combination of three or more antibiotics. A satisfactory response was noted for 62 and 76 percent of the patients with nosocomial and community-acquired pneumonias, respectively. Twenty percent of the pneumonia patients were switched to oral drug after an average of five days of therapy and discharged from the hospital. Twenty-five adverse events that were possibly or probably related to the antibiotic regimen were reported in 23 of the 350 patients for an overall incidence of 6.5 percent. The results of this survey provide a cross-sectional view of antibiotic prescribing patterns for the treatment of bacterial pneumonia and the outcome of therapy under actual clinical conditions of use.

An evaluation of antibiotic prescribing patterns in adult intensive care units in a private hospital in KwaZulu-Natal

Southern African Journal of Infectious Diseases ◽

10.1080/23120053.2015.1103956 ◽

2015 ◽

Vol 30 (1) ◽

pp. 17-22 ◽

Cited By ~ 1

Author(s):

Dipika Chunnilall ◽

Abdool Peer ◽

Indirani Naidoo ◽

Sabiha Essack

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Private Hospital ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Kwazulu Natal

Informing the development of a standardised approach to measure antibiotic use in secondary care: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2018-026792 ◽

2019 ◽

Vol 9 (5) ◽

pp. e026792

Author(s):

Selina Patel ◽

Arnoupe Jhass ◽

Susan Hopkins ◽

Laura Shallcross

Keyword(s):

Secondary Care ◽

Scale Up ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Antibiotic Usage ◽

Prescribing Patterns ◽

Primary Data ◽

Antibiotic Prescribing ◽

Cochrane Central Register ◽

Antibiotic Consumption Surveillance

IntroductionEcological and individual-level evidence indicates that there is an association between level of antibiotic exposure and the emergence and spread of antibiotic resistance. The Global Point Prevalence Survey in 2015 estimated that 34.4% of hospital inpatients globally received at least one antimicrobial. Antimicrobial stewardship to optimise antibiotic use in secondary care can reduce the high risk of patients acquiring and transmitting drug-resistant infections in this setting. However, differences in the availability of data on antibiotic use in this context make it difficult to develop a consensus of how to comparably monitor antibiotic prescribing patterns across secondary care. This review will aim to document and critically evaluate methods and measures to monitor antibiotic use in secondary care.Methods and analysisWe will search Medline (Ovid), Embase (Ovid), Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and websites of key organisations for published reports where an attempt to measure antibiotic usage among adult inpatients in high-income hospital settings has been made. Two independent reviewers will screen the studies for eligibility, extract data and assess the study quality using the Newcastle-Ottawa scale. A description of the methods and measures used in antibiotic consumption surveillance will be presented. An adaptation of the Affordability, Practicability, Effectiveness, Acceptability, Side-effects Equity framework will be used to consider the practicality of implementing different approaches to measuring antibiotic usage in secondary care settings. A descriptive comparison of definitions and estimates of (in)appropriate antibiotic usage will also be carried out.Ethics and disseminationEthical approval is not required for this study as no primary data will be collected. The results will be published in relevant peer-reviewed journals and presented at relevant conferences or meetings where possible. This review will inform future approaches to scale up antibiotic consumption surveillance strategies to attempt to maximise impact through standardisation.PROSPERO registration numberCRD42018103375

Diagnostic Stewardship in Lower Respiratory Tract Infections Using Procalcitonin

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.58 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s31-s32

Author(s):

Amanda Gusovsky ◽

David Burgess ◽

Donna Burgess ◽

Emily Slade ◽

Chris Delcher ◽

...

Keyword(s):

Length Of Stay ◽

Infectious Diseases ◽

Respiratory Tract ◽

Lower Respiratory Tract ◽

Respiratory Tract Infections ◽

Length Of Hospital Stay ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Lower Respiratory Tract Infections ◽

Tract Infections

Background: A team of infectious diseases physicians, infectious diseases pharmacists, clinical laboratorians, and researchers collaborated to assess the management of lower respiratory tract infections (LRTIs). In 1 sample from our institution, 96.1% of pneumonia cases were prescribed antibiotics, compared to 85.0% in a comparison group. A collaborative effort led to the development of a protocol for procalcitonin (PCT)-guided antibiotic prescribing that was approved by several hospital committees, including the Antimicrobial Stewardship Committee and the Healthcare Pharmacy & Therapeutics Committee in December 2020. The aim of this analysis was to develop baseline information on PCT ordering and antibiotic prescribing patterns in LRTIs. Methods: We evaluated all adult inpatients (March–September 2019 and 2020) with a primary diagnosis of LRTI who received at least 1 antibiotic. Two cohorts were established to observe any potential differences in the 2 most recent years prior to adoption of the PCT protocol. Data (eg, demographics, specific diagnosis, length of stay, antimicrobial therapy and duration, PCT labs, etc) were obtained from the UK Center for Clinical and Translational Science, and the study was approved by the local IRB. The primary outcome of interest was antibiotic duration; secondary outcomes of interest were PCT orders, discharge antibiotic prescription, and inpatient length of stay. Results: In total, 432 patients (277 in 2019 and 155 in 2020) were included in this analysis. The average patient age was 61.2 years (SD, ±13.7); 47.7% were female; and 86.1% were white. Most patients were primarily diagnosed with pneumonia (58.8%), followed by COPD with complication (40.5%). In-hospital mortality was 3.5%. The minority of patients had any orders for PCT (29.2%); among them, most had only 1 PCT level measured (84.1%). The median length of hospital stay was 4 days (IQR, 2–6), and the median duration of antibiotic therapy was 4 days (IQR, 3–6). Conclusions: The utilization of PCT in LRTIs occurs in the minority of patient cases at our institution and mostly as a single measurement. The development and implementation of a PCT-guided therapy could help optimize antibiotic usage in patients with LRTIs.Funding: NoDisclosures: None

Utilizing Pharmacy Records to Assess Antibiotic Prescribing Patterns on the Incidence of Community-Acquired Methicillin-Resistant Staphylococcus aureus Infections in Children

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-12.2.91 ◽

2007 ◽

Vol 12 (2) ◽

pp. 91-101

Author(s):

Peter N. Johnson ◽

Robert P. Rapp ◽

Christopher T. Nelson ◽

J.S. Butler ◽

Sue Overman ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Antibiotic Therapy ◽

Methicillin Resistant Staphylococcus Aureus ◽

Prescribing Patterns ◽

Control Group ◽

Antibiotic Prescribing ◽

Antibiotic Exposure ◽

Pharmacy Records ◽

Methicillin Resistant ◽

Prior Antibiotic Therapy

OBJECTIVE To assess the effect of prior antibiotic therapy on the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in children. METHODS This was a concurrent and retrospective review of antibiotic records for children < 18 years of age with documented CA-MRSA infection identified between January 1, 2004, and December 31, 2005. Antibiotic records were compared against a control group. The primary outcome was the incidence of CA-MRSA using linear regression as a function of age and prior antibiotic therapy (i.e., 3 months prior to admission). Secondary objectives included a comparison of antibiotic courses and classes and a description of antibiotic susceptibilities in patients with CA-MRSA RESULTS Data from 26 patients were included. Nine out of 51 patients (18%) with CA-MRSA were included. Another 17 children were enrolled in the control group. The median age was approximately 1.75 years (0.08–14 years) in the CA-MRSA group versus 2.75 years (0.005-15 years) in the control group. A statistical difference was noted in the number of patients with prior antibiotic exposure between the CA-MRSA and control group, 8 (88.9%) versus 6 (35.3%), respectively (P = .01). Antibiotic exposure was found to be a significant independent risk factor (P = .005; 95% CI, 0.167–0.846) for the development of CA-MRSA. The interaction between antibiotic exposure and age < 3 was the most significant predictor of CA-MRSA (P = .019; 95% CI, 0.139–1.40). CONCLUSIONS Prior antibiotic therapy in patients < 3 years of age was associated with a significant risk of developing CA-MRSA. A comprehensive assessment of CA-MRSA patients should include objective methods of measuring prior antibiotic exposure such as pharmacy records.