Use of Antibiotics among Residents Living Close to Poultry or Goat Farms: A Nationwide Analysis in The Netherlands

Prior regional studies found a high risk of pneumonia for people living close to poultry and goat farms. This epidemiological study in the Netherlands used nationwide antibiotic prescription data as a proxy for pneumonia incidence to investigate whether residents of areas with poultry and goat farms use relatively more antibiotics compared to areas without such farms. We used prescription data on antibiotics most commonly prescribed to treat pneumonia in adults and livestock farming data, both with nationwide coverage. Antibiotic use was expressed as defined daily doses per (4-digit Postal Code (PC4) area)-(age group)-(gender)-(month) combination for the year 2015. We assessed the associations between antibiotic use and farm exposure using negative binomial regression. The amoxicillin, doxycycline, and co-amoxiclav use was significantly higher (5–10% difference in use) in PC4 areas with poultry farms present compared to areas without, even after adjusting for age, gender, smoking, socio-economic status, and goat farm presence. The adjusted models showed no associations between antibiotic use and goat farm presence. The variables included in this study could only partly explain the observed regional differences in antibiotic use. This was an ecological study that precludes inference about causal relations. Further research using individual-level data is recommended.

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1960. Lost in Translation: Comparing Rates of Outpatient Antibiotic Use in Three Metrics

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.137 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S62-S63

Author(s):

Christopher Prestel ◽

Laura M King ◽

Monina Bartoces ◽

Melinda M Neuhauser ◽

Lauri Hicks ◽

...

Keyword(s):

Negative Binomial ◽

National Level ◽

Negative Binomial Regression ◽

Antibiotic Use ◽

World Health ◽

Oral Antibiotic ◽

Defined Daily Doses ◽

Days Of Therapy ◽

Health Organization ◽

Over Time

Abstract Background The Centers for Disease Control and Prevention (CDC) tracks US outpatient antibiotic use in prescriptions per 1000 persons (Rx/1000), while the World Health Organization uses defined daily doses per 1000 persons (DDD/1000), which are based on average adult dose, for global surveillance. A third metric, days of therapy (DOT)/1,000 persons, has not been previously evaluated at the national level. We aim to compare time trends in outpatient oral antibiotic use as Rx/1000, DDD/1000, and DOT/1,000 in the same data to inform ongoing CDC surveillance and facilitate international comparison. Methods We identified dispensed outpatient oral antibiotics using pharmacy claims in 2011–2016 IBM® MarketScan® Commercial Databases for individuals <65 years old. Using enrollment data, we calculated mean annual membership with drug coverage. Annual rates of outpatient oral antibiotic use were calculated for Rx/1000, DDD/1000, and DOT/1000 persons. Prescriptions written with a ratio of DDD to days supplied >10 were considered biologically implausible and excluded from DDD calculations. We examined trends for each metric from 2011 to 2016 using negative binomial regression. Results Annual numbers of outpatient oral antibiotic prescriptions ranged from 18.6 million to 30.0 million (mean 24.3 million). Overall, Rx/1000 decreased by 7% from 892 in 2011 to 829 in 2016 (Figure 1). From 2011 to 2016, DDD/1000 increased 2% from 23.8 to 24.2 while DOT/1000 decreased 9% from 25.4 to 23.1. Significant per-year decreases were found from 2011 to 2016 for Rx/1000 (−1.1%) and for DOT/1000 (−1.6%), while no significant per-year change was seen with DDD/1000 (table). DDD/1000 underestimate use in pediatrics under the age of 10 (Figure 2). Prolonged duration is seen in adolescents and reflected by DOT/1000. Conclusion Trends in DDD/1000 for population aged <65 years do not mirror trends in Rx/1000 and DOT/1000. These differences may reflect that Rx/1000 and DOT/1000 more accurately capture antibiotic prescriptions in children than DDD/1000. As DDD/1000 underestimate antibiotic use in children, DDD/1000 underestimates reduction in antibiotic use over time and may not accurately reflect changes in use over time. Disclosures All Authors: No reported Disclosures.

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Divergent associations between incident hypertension and deprivation based on different sources of case identification

Chronic Diseases and Injuries in Canada ◽

10.24095/hpcdp.32.3.02 ◽

2012 ◽

Vol 32 (3) ◽

pp. 121-130 ◽

Cited By ~ 1

Author(s):

J. Aubé-Maurice ◽

L. Rochette ◽

C. Blais

Keyword(s):

Negative Binomial ◽

Social Deprivation ◽

Economic Status ◽

Negative Binomial Regression ◽

Administrative Databases ◽

Incident Hypertension ◽

Case Identification ◽

Physician Billing ◽

Combining Data ◽

Incident Cases

Introduction Studies suggest that hypertension is more prevalent in the most deprived. Our objective was to examine the association between incident hypertension and deprivation in Quebec based on different modes of case identification, using two administrative databases. Methods We identified new incident cases of hypertension in 2006/2007 in the population aged 20 years plus. Socio-economic status was determined using a material and social deprivation index. Negative binomial regression analyses were carried out to examine the association between incident hypertension and deprivation, adjusting for several covariates. Results We found a positive and statistically significant association between material deprivation and incident hypertension in women, irrespective of the identifying database. Using the hospitalization database, the incidence of hypertension increased for both sexes as deprivation increased, except for social deprivation in women. However, whether using the physician billing database or the validated definition of hypertension obtained by combining data from the two databases, the incidence of hypertension decreased overall as deprivation increased. Conclusion Associations between hypertension and deprivation differ based on the database used: they are generally positively associated with the hospitalization database and inversely with the standard definition and the physician billing database, which suggests a consultation bias in favour of the most socio-economically advantaged.

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2089. Effect of the Duke Antimicrobial Stewardship Outreach Network (DASON): A Multi-Center Time Series Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1769 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S705-S706

Author(s):

Michael E Yarrington ◽

Elizabeth Dodds Ashley ◽

Melissa D Johnson ◽

Angelina Davis ◽

April Dyer ◽

...

Keyword(s):

Broad Spectrum ◽

Negative Binomial ◽

Statistical Significance ◽

Cohort Analysis ◽

Negative Binomial Regression ◽

Antibiotic Use ◽

First Year ◽

Hospital Data ◽

Hospital Size ◽

Days Of Therapy

Abstract Background DASON is a 30-member, community hospital network in the southeastern United States that supports the development and growth of local antibiotic stewardship programs (ASPs). Collaborative activities include on-site visits from liaison clinical pharmacists, data sharing for routine feedback and benchmarking, and educational programs. Methods We performed a retrospective cohort analysis of antibiotic use (AU) in 17 hospitals that participated in DASON for a minimum of 42 months during 2013–2018. Segmented negative binomial regression models were used to estimate the change in facility-wide AU after an initial 1-year assessment, planning, and ASP intervention initiation period. Baseline AU trend (1 to 12 months) was compared against AU following the first year (13 to 42 months). Monthly AU rates were measured in days of therapy (DOT) per 1,000 patient-days (pd). Models assessed overall AU and specific antibiotic groups, as defined by the National Healthcare Safety Network AU option. The models controlled for hospital size, presence of a pre-existing formal ASP upon network entry, and year of network entry. Results Hospital data included a total of 2,988,930 pd over 5 years. Facility-wide AU was increasing during the first year of network entry and then began decreasing by 0.2% per month (P = 0.01, figure). Fluoroquinolone use was stagnant in year one and then decreased by 1.5% per month (P ≤ 0.001, figure). Antifungal agents were decreasing in year one and continued to decrease 0.7% per month thereafter (P = 0.03, figure). Agents predominantly used for resistant Gram-positive infections and broad-spectrum agents used for hospital-onset infections were increasing during year one and then attenuated afterward, though the slope change did not reach statistical significance. The presence of a pre-existing formal ASP was not a significant covariate in any model, while bed size and year of network entry significantly contributed to models of some antibiotic groups. Conclusion Participation in DASON was associated with a decline in total AU and fluoroquinolone use, and a trend toward attenuated use of other broad-spectrum agents in community hospitals. Collaborative network experiences can help local ASPs achieve reductions in AU. Disclosures All authors: No reported disclosures.

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Determinants of Overnight Stay in Health Centres and Length of Admission: A Study of Canadian Seniors

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.1017/s0714980819000771 ◽

2020 ◽

Vol 39 (4) ◽

pp. 533-544 ◽

Cited By ~ 2

Author(s):

Prince M. Amegbor ◽

Kyle B. Plumb ◽

Mark W. Rosenberg

Keyword(s):

Cardiovascular Health ◽

Negative Binomial ◽

Economic Status ◽

Negative Binomial Regression ◽

Chronic Health Conditions ◽

Health Conditions ◽

Lower Income ◽

Chronic Health ◽

Socio Economic Status ◽

Hospital Stays

ABSTRACTThis study examines the influence of chronic health conditions and socio-economic status on overnight admission and length of stay among Canadian seniors. Incremental multivariate logistic and zero-inflated negative binomial regression models assessed the relationship between selected predictors, overnight admission, and duration of stay. The findings show that all chronic health conditions and socio-economic factors examined were significantly associated with overnight hospital admission. However, seniors with cardiovascular health conditions, the very old, and seniors living in lower-income households had a greater risk of longer stays. Canadian seniors diagnosed with hypertension, cancer, diabetes, and stroke had greater risk of longer overnight hospital stays. Seniors aged 75 to 79 years, 80 years or older, and those living in lower-income households (≤ $39,999) were more likely to have a longer overnight hospital stay. Findings suggest that improving seniors’ health and socio-economic status may reduce the risk of overnight admission and longer stays of hospitalisation.

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Impact of the Centers for Medicare and Medicaid Services Sepsis Core Measure on Antibiotic Use

Clinical Infectious Diseases ◽

10.1093/cid/ciaa456 ◽

2020 ◽

Cited By ~ 1

Author(s):

Amy L Pakyz ◽

Christine M Orndahl ◽

Alicia Johns ◽

David W Harless ◽

Daniel J Morgan ◽

...

Keyword(s):

Broad Spectrum ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Interrupted Time Series ◽

Antibiotic Use ◽

Multidrug Resistant ◽

Clostridioides Difficile ◽

Core Measure ◽

The Impact

Abstract Background The Centers for Medicare and Medicaid Services (CMS) implemented a core measure sepsis (SEP-1) bundle in 2015. One element was initiation of broad-spectrum antibiotics within 3 hours of diagnosis. The policy has the potential to increase antibiotic use and Clostridioides difficile infection (CDI). We evaluated the impact of SEP-1 implementation on broad-spectrum antibiotic use and CDI occurrence rates. Methods Monthly adult antibiotic data for 4 antibiotic categories (surgical prophylaxis, broad-spectrum for community-acquired infections, broad-spectrum for hospital-onset/multidrug-resistant [MDR] organisms, and anti–methicillin-resistant Staphylococcus aureus [MRSA]) from 111 hospitals participating in the Clinical Data Base Resource Manager were evaluated in periods before (October 2014–September 2015) and after (October 2015–June 2017) policy implementation. Interrupted time series analyses, using negative binomial regression, evaluated changes in antibiotic category use and CDI rates. Results At the hospital level, there was an immediate increase in the level of broad-spectrum agents for hospital-onset/MDR organisms (+2.3%, P = .0375) as well as a long-term increase in trend (+0.4% per month, P = .0273). There was also an immediate increase in level of overall antibiotic use (+1.4%, P = .0293). CDI rates unexpectedly decreased at the time of SEP-1 implementation. When analyses were limited to patients with sepsis, there was a significant level increase in use of all antibiotic categories at the time of SEP-1 implementation. Conclusions SEP-1 implementation was associated with immediate and long-term increases in broad-spectrum hospital-onset/MDR organism antibiotics. Antimicrobial stewardship programs should evaluate sepsis treatment for opportunities to de-escalate broad therapy as indicated.

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Twitter and Facebook: Populists’ double-barreled gun?

New Media & Society ◽

10.1177/1461444819893991 ◽

2020 ◽

Vol 22 (4) ◽

pp. 611-633

Author(s):

Kristof Jacobs ◽

Linn Sandberg ◽

Niels Spierings

Keyword(s):

Social Media ◽

The Netherlands ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Members Of Parliament ◽

Binomial Regression ◽

Content Analyses

Social media are said to be a core driver of populists’ current success. Yet, our knowledge of how populist politicians use social media is limited. We argue that they can use Twitter and Facebook, politically the most important platforms, as a “double-barreled gun,” each serving a different target. Based on the architecture of the platforms and the populist ideology, we expect that Twitter is used to name and shame journalists publicly, Facebook to activate anger among citizens. Both types of use are examined by studying the Members of Parliament (MPs) of Austria, The Netherlands, and Sweden. We collected 9852 tweets for the 475 MPs on Twitter and 10,355 Facebook posts from the 287 MPs with a Facebook Page. Using negative binomial regression and content analyses, we find that populists seem eager to activate anger. They are not more likely to @-mention media accounts, but “shame” them roughly three times more often.

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The Prevalence of Multi-Drug Resistant Organisms and Their Outcomes in an ICU in Mauritius: An Observational Study

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2020/v18i1130270 ◽

2020 ◽

pp. 71-78

Author(s):

Dooshanveer Chowbay Nuckchady ◽

Samiihah Hafiz Boolaky

Keyword(s):

Length Of Stay ◽

Negative Binomial ◽

Cox Regression ◽

Negative Binomial Regression ◽

Antibiotic Use ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Drug Resistant ◽

Retrospective Case ◽

Carbapenem Resistant

Aims: To assess the prevalence of multi-drug resistant organisms (MDRO) in an ICU of Mauritius and determine the relationship between antibiotic resistance and mortality as well as length of stay and duration of antibiotic use. Study Design: Retrospective case control study. Place and Duration of Study: This study examined the data of patients who were admitted from 2015 to 2016 at an ICU in Port Louis, Mauritius. Methodology: 128 patients on whom cultures were ordered were included. Adjustment was performed using multivariate Cox regression and negative binomial regression. Results: Out of 214 organisms that were isolated, 68% were an MDRO; 78% of Enterobacteriaceae were ESBL, 86% of Acinetobacter spp., 30% of Enterobacteriaceae and 80% of Pseudomonas spp. were carbapenem resistant while 53% of Staphylococcus aureus were MRSA. After adjustment, MDRO were linked to a non-statistically significant 13% increase in mortality (P = .056), a rise in hospital length of stay from 19 days to 29 days (P = .0013) and an escalation in duration of antibiotic use from 11 days to 24 days (P = 1.3E-10). Conclusion: Infections with MDRO are common in Mauritius and strategies should be put into place to reduce their prevalence.

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Turning green: the impact of changing to more eco-friendly respiratory healthcare. A carbon and cost analysis of Dutch prescription data.

10.1101/2021.11.20.21266571 ◽

2021 ◽

Author(s):

Pieter ten Have ◽

Peter van Hal ◽

Iris Wichers ◽

Johan Kooistra ◽

Paul Hagedoorn ◽

...

Keyword(s):

The Netherlands ◽

Chronic Obstructive ◽

Prescription Data ◽

Obstructive Pulmonary Disease ◽

Potential Reduction ◽

Defined Daily Doses ◽

Number Of Patients ◽

Metered Dose ◽

Annual Reduction ◽

The Impact

Objectives Dry powder inhalers (DPIs) have a substantially lower global warming potential than pressurized metered-dose inhalers (MDIs). To help mitigate climate change, we assessed the potential reduction in CO2-equivalents when replacing MDIs by DPIs in the Netherlands, and estimated the associated cost. Design We performed a four-step analysis based on data from two national databases of two independent governmental bodies (Dutch National Healthcare Institute and the Dutch Healthcare Authority). First, we calculated the number of patients with Chronic Obstructive Pulmonary Disease (COPD) and asthma that were using inhalation medication (2020). Second, we calculated the number and total of daily defined doses of MDIs, DPIs, and soft mist inhalers and the number of spacers per patients, dispensed by non-hospital based pharmacies in 2020. Third, we estimated the potential reduction in CO2-equivalents (eq.) if all eligible patients (≥7 years old; COPD with ≤exacerbation per year) would switch from using MDIs to using DPIs as eco-friendly alternatives. Fourth, we performed a cost-effectiveness analysis. Results In 2020, 1.4 million patients used inhalers for COPD or asthma treatment. A total of 460 million defined daily doses (DDDs) from inhalers were dispensed, of which, after the exclusion of nebulisers, 50.4% were from MDIs. We estimated that this use could be reduced by 70% leading to annual reduction in emissions of 77 - 84 million kg CO2eq. saving at best EUR 49.8 million annually. Conclusions In the Netherlands, substitution of MDIs to DPIs for eligible patients is theoretically safe and in accordance with medical guidelines, while reducing emissions by 80 million kg.CO2eq. on average and saving at best EUR 49.8 million per year. This study confirms the potential climate and economic benefit of delivering eco-friendlier respiratory care.

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Significant Regional Differences in Antibiotic Use Across 576 US Hospitals and 11 701 326 Adult Admissions, 2016–2017

Clinical Infectious Diseases ◽

10.1093/cid/ciaa570 ◽

2020 ◽

Cited By ~ 2

Author(s):

Katherine E Goodman ◽

Sara E Cosgrove ◽

Lisa Pineles ◽

Laurence S Magder ◽

Deverick J Anderson ◽

...

Keyword(s):

Regional Differences ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Antibiotic Use ◽

Fourth Generation ◽

Teaching Hospitals ◽

Antibiotic Prescribing ◽

Healthcare Database ◽

Days Of Therapy ◽

Adult Inpatient

Abstract Background Quantifying the amount and diversity of antibiotic use in United States hospitals assists antibiotic stewardship efforts but is hampered by limited national surveillance. Our study aimed to address this knowledge gap by examining adult antibiotic use across 576 hospitals and nearly 12 million encounters in 2016–2017. Methods We conducted a retrospective study of patients aged ≥ 18 years discharged from hospitals in the Premier Healthcare Database between 1 January 2016 and 31 December 2017. Using daily antibiotic charge data, we mapped antibiotics to mutually exclusive classes and to spectrum of activity categories. We evaluated relationships between facility and case-mix characteristics and antibiotic use in negative binomial regression models. Results The study included 11 701 326 admissions, totaling 64 064 632 patient-days, across 576 hospitals. Overall, patients received antibiotics in 65% of hospitalizations, at a crude rate of 870 days of therapy (DOT) per 1000 patient-days. By class, use was highest among β-lactam/β-lactamase inhibitor combinations, third- and fourth-generation cephalosporins, and glycopeptides. Teaching hospitals averaged lower rates of total antibiotic use than nonteaching hospitals (834 vs 957 DOT per 1000 patient-days; P < .001). In adjusted models, teaching hospitals remained associated with lower use of third- and fourth-generation cephalosporins and antipseudomonal agents (adjusted incidence rate ratio [95% confidence interval], 0.92 [.86–.97] and 0.91 [.85–.98], respectively). Significant regional differences in total and class-specific antibiotic use also persisted in adjusted models. Conclusions Adult inpatient antibiotic use remains high, driven predominantly by broad-spectrum agents. Better understanding reasons for interhospital usage differences, including by region and teaching status, may inform efforts to reduce inappropriate antibiotic prescribing.

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Antibiotic Stewardship Implementation and Antibiotic Use at Hospitals With and Without On-site Infectious Disease Specialists

Clinical Infectious Diseases ◽

10.1093/cid/ciaa388 ◽

2020 ◽

Author(s):

Daniel J Livorsi ◽

Rajeshwari Nair ◽

Brian C Lund ◽

Bruce Alexander ◽

Brice F Beck ◽

...

Keyword(s):

Infectious Disease ◽

Antibiotic Stewardship ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Antibiotic Use ◽

Negative Binomial Regression Model ◽

Veterans Health ◽

Health Administration ◽

Patient Admissions ◽

Days Of Therapy

Abstract Background Many US hospitals lack infectious disease (ID) specialists, which may hinder antibiotic stewardship efforts. We sought to compare patient-level antibiotic exposure at Veterans Health Administration (VHA) hospitals with and without an on-site ID specialist, defined as an ID physician and/or ID pharmacist. Methods This retrospective VHA cohort included all acute-care patient admissions during 2016. A mandatory survey was used to identify hospitals’ antibiotic stewardship processes and their access to an on-site ID specialist. Antibiotic use was quantified as days of therapy per days present and categorized based on National Healthcare Safety Network definitions. A negative binomial regression model with risk adjustment was used to determine the association between presence of an on-site ID specialist and antibiotic use at the level of patient admissions. Results Eighteen of 122 (14.8%) hospitals lacked an on-site ID specialist; there were 525 451 (95.8%) admissions at ID hospitals and 23 007 (4.2%) at non-ID sites. In the adjusted analysis, presence of an ID specialist was associated with lower total inpatient antibacterial use (odds ratio, 0.92; 95% confidence interval, .85–.99). Presence of an ID specialist was also associated with lower use of broad-spectrum antibacterials (0.61; .54–.70) and higher narrow-spectrum β-lactam use (1.43; 1.22–1.67). Total antibacterial exposure (inpatient plus postdischarge) was lower among patients at ID versus non-ID sites (0.92; .86–.99). Conclusions Patients at hospitals with an ID specialist received antibiotics in a way more consistent with stewardship principles. The presence of an ID specialist may be important to effective antibiotic stewardship.

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