Antibiotic Prescribing Practices for Catheter Urine Culture Results

Background: Suspicion of urinary tract infection (UTI) is the most common justification for prescribing antibiotics in nursing homes. More than half of antibiotic prescriptions for treatment of UTI in nursing homes are either unnecessary or inappropriate. Achieving a better understanding of the factors that underlie UTI treatment decisions is necessary to improve the quality of antibiotic prescribing in nursing homes. An ongoing hybrid type 2 effectiveness-implementation cluster randomized trial of a recently developed nursing home UTI recognition and management tool kit provided us with an opportunity to explore the influence of organizational, clinical, and staff attributes on UTI antibiotic prescribing practices in nursing homes. Methods: Data on antibiotic starts for suspected UTIs were collected in 29 nursing homes over a 9-month period. Antibiotic practices evaluated included total antibiotic starts per 1,000 resident days, % antibiotic starts with treatment duration >7 days, % antibiotic starts in which the initial antibiotic choice was a fluoroquinolone, and % antibiotic starts meeting UTI tool-kit criteria of appropriateness. Prior research and bivariate analyses were used to select clinical and organizational attributes as well as individual nursing staff-level retention rates for inclusion in a stepwise linear regression model for each antibiotic practice outcome. Results: In total, 602 UTI antibiotic events were evaluated. Four associations were identified for antibiotic starts including nursing home urine culture rate, ICP status, nonprofit and part-time LPN retention. Nursing homes with higher full-time LPN retention had a lower rate of antibiotic treatment duration >7 days. Full-time CNAs and part-time LPNs retention and for-profit status was associated with the proportion of fluoroquinolone antibiotic starts. No attributes influenced the proportion of antibiotic starts meeting appropriateness criteria (Fig. 1). Urine culture rates are driving overall nursing home antibiotic prescribing. Conclusions: Urine culture practices was strongly associated with UTI treatment rates in nursing homes. A variety of organizational characteristics were also associated with UTI treatment rates as well as other UTI antibiotic prescribing practices. Some of these associations appear paradoxical but may reflect increasing resident acuity and increased capacity to standardize practices through organizational centralization.Funding: Support for the project provided by the Wisconsin Partnership Program.Disclosures: None

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Practice-Level Association between Antibiotic Prescribing and Resistance: An Observational Study in Primary Care

Antibiotics ◽

10.3390/antibiotics9080470 ◽

2020 ◽

Vol 9 (8) ◽

pp. 470

Author(s):

Dylan Batenburg ◽

Theo Verheij ◽

Annemarie van’t Veen ◽

Alike van der Velden

Keyword(s):

Primary Care ◽

Urine Culture ◽

Antibiotic Use ◽

Urine Samples ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Susceptibility Data ◽

Country Level ◽

Practice Population ◽

Primary Care Practices

A direct relation between antibiotic use and resistance has been shown at country level. We aim to investigate the association between antibiotic prescribing for patients from individual Dutch primary care practices and antibiotic resistance of bacterial isolates from routinely submitted urine samples from their patient populations. Practices’ antibiotic prescribing data were obtained from the Julius Network and related to numbers of registered patients. Practices were classified as low-, middle- or high-prescribers and from each group size-matching practices were chosen. Culture and susceptibility data from submitted urine samples were obtained from the microbiology laboratory. Percentages of resistant isolates, and resistant isolates per 1000 registered patients per year (population resistance) were calculated and compared between the groups. The percentages of resistant Escherichia coli varied considerably between individual practices, but the three prescribing groups’ means were very similar. However, as the higher-prescribing practices requested more urine cultures per 1000 registered patients, population resistance was markedly higher in the higher-prescribing groups. This study showed that the highly variable resistance percentages for individual practices were unrelated to antibiotic prescribing levels. However, population resistance (resistant strains per practice population) was related to antibiotic prescribing levels, which was shown to coincide with numbers of urine culture requests. Whether more urine culture requests in the higher-prescribing groups were related to treatment failures, more complex patient populations, or to general practitioners’ testing behaviour needs further investigation.

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A retrospective audit of antibiotic prescriptions in a Lebanese Hospital

International Journal of Infection Control ◽

10.3396/ijic.v15i1.001.19 ◽

2019 ◽

Vol 15 (1) ◽

Author(s):

Mohamad Ibrahim ◽

Zeinab Bazzi

Keyword(s):

Epidemiological Data ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Team Approach ◽

Strong Correlations ◽

Prescribing Practices ◽

Antimicrobial Drugs ◽

Stewardship Program ◽

Retrospective Audit ◽

Attending Physician

Despite the frequent alarms that have been published about the adverse effects of antibiotic use and misuse, physicians prescribe to patients approximately fifty percent of unnecessary antimicrobials. In an attempt to decrease the emergence of antimicrobial resistance and increase awareness, a team approach is required to address this prescribing phenomenon in a feasible manner. A retrospective study was done at a one-hundred-forty-bed hospital with a representative sample size of 368 patients. Patient data was collected and analyzed by a stewardship team. The overall antibiotic inappropriate rate was 45.8%, which is relatively high and consistent with the findings of other studies mentioned in the literature. This study aimed to provide baseline epidemiological data on the use of antibiotics in a Lebanese hospital and has revealed several notable patterns of antibiotic prescribing practices among Lebanese physicians such as the use of antimicrobial drugs example penicillin was consistently high. Strong correlations were identified between the type of attending physician and antibiotic appropriateness. These findings will be important in constructing an antimicrobial stewardship program to reduce antibiotic misuse.

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Antibiotic prescription for febrile outpatients: a health facility-based secondary data analysis for the Greater Accra region of Ghana

BMC Health Services Research ◽

10.1186/s12913-020-05771-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Michael Mireku Opoku ◽

Harriet Affran Bonful ◽

Kwadwo Ansah Koram

Keyword(s):

Antibiotic Prescription ◽

Secondary Data ◽

Health Facilities ◽

Full Blood Count ◽

Baseline Survey ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Factors Associated ◽

Laboratory Investigations ◽

Greater Accra Region

Abstract Background Misguided prescription of antibiotics is an important contributor towards the emergence and spread of antibiotic resistance. The absence of effective interventions to control antibiotic use leads to increased consumption beyond the needed requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the controlled use of antibiotics. The objective of this study was to determine the factors associated with antibiotic prescription to febrile outpatients who seek care in health facilities within the Greater Accra region of Ghana. Methods Secondary data obtained from the medical records of 2519 febrile outpatients, consecutively sampled at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2015 was used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotic prescription. Results The prevalence of antibiotic prescription was 70.1% (95% CI: 67.7–72.4). Prescribers with more years of practice (> 5 years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p < 0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) fold odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to receive antibiotics compared with those under 5 years (AOR = 0.40, 95% CI: 0.32, 0.51; p < 0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed antibiotics than those not referred. The presence of cough as a presenting symptom was associated with a 3.5 (95% CI: 2.54, 4.92) fold odds of antibiotic prescription. Conclusion Prescription of antibiotics to febrile outpatients was high. Promoting laboratory testing can potentially reduce irrational antibiotic prescription. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

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Implementing interventions to reduce antibiotic use: a qualitative study in high-prescribing practices

BMC Family Practice ◽

10.1186/s12875-021-01371-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Aleksandra J. Borek ◽

◽

Anne Campbell ◽

Elle Dent ◽

Christopher C. Butler ◽

...

Keyword(s):

Focus Groups ◽

Point Of Care ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Focus Group Study ◽

Clinical Uncertainty ◽

Reactive Protein ◽

Clinical Tools ◽

The Many

Abstract Background Trials have shown that delayed antibiotic prescriptions (DPs) and point-of-care C-Reactive Protein testing (POC-CRPT) are effective in reducing antibiotic use in general practice, but these were not typically implemented in high-prescribing practices. We aimed to explore views of professionals from high-prescribing practices about uptake and implementation of DPs and POC-CRPT to reduce antibiotic use. Methods This was a qualitative focus group study in English general practices. The highest antibiotic prescribing practices in the West Midlands were invited to participate. Clinical and non-clinical professionals attended focus groups co-facilitated by two researchers. Focus groups were audio-recorded, transcribed verbatim and analysed thematically. Results Nine practices (50 professionals) participated. Four main themes were identified. Compatibility of strategies with clinical roles and experience – participants viewed the strategies as having limited value as ‘clinical tools’, perceiving them as useful only in ‘rare’ instances of clinical uncertainty and/or for those less experienced. Strategies as ‘social tools’ – participants perceived the strategies as helpful for negotiating treatment decisions and educating patients, particularly those expecting antibiotics. Ambiguities – participants perceived ambiguities around when they should be used, and about their impact on antibiotic use. Influence of context – various other situational and practical issues were raised with implementing the strategies. Conclusions High-prescribing practices do not view DPs and POC-CRPT as sufficiently useful ‘clinical tools’ in a way which corresponds to the current policy approach advocating their use to reduce clinical uncertainty and improve antimicrobial stewardship. Instead, policy attention should focus on how these strategies may instead be used as ‘social tools’ to reduce unnecessary antibiotic use. Attention should also focus on the many ambiguities (concerns and questions) about, and contextual barriers to, using these strategies that need addressing to support wider and more consistent implementation.

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Antibiotic Susceptibility of Common Organisms Isolated from Urine Cultures of Nursing Home Residents

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.626 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s118-s120

Author(s):

Austin R. Penna ◽

Taniece R. Eure Eure ◽

Nimalie D. Stone ◽

Grant Barney ◽

Devra Barter ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Antibiotic Susceptibility ◽

Clinical Decision Making ◽

Service Providers ◽

Urine Culture ◽

Nursing Home Residents ◽

Antibiotic Prescribing ◽

E Coli ◽

Susceptibility Data

Background: With the emergence of antibiotic resistant threats and the need for appropriate antibiotic use, laboratory microbiology information is important to guide clinical decision making in nursing homes, where access to such data can be limited. Susceptibility data are necessary to inform antibiotic selection and to monitor changes in resistance patterns over time. To contribute to existing data that describe antibiotic resistance among nursing home residents, we summarized antibiotic susceptibility data from organisms commonly isolated from urine cultures collected as part of the CDC multistate, Emerging Infections Program (EIP) nursing home prevalence survey. Methods: In 2017, urine culture and antibiotic susceptibility data for selected organisms were retrospectively collected from nursing home residents’ medical records by trained EIP staff. Urine culture results reported as negative (no growth) or contaminated were excluded. Susceptibility results were recorded as susceptible, non-susceptible (resistant or intermediate), or not tested. The pooled mean percentage tested and percentage non-susceptible were calculated for selected antibiotic agents and classes using available data. Susceptibility data were analyzed for organisms with ≥20 isolates. The definition for multidrug-resistance (MDR) was based on the CDC and European Centre for Disease Prevention and Control’s interim standard definitions. Data were analyzed using SAS v 9.4 software. Results: Among 161 participating nursing homes and 15,276 residents, 300 residents (2.0%) had documentation of a urine culture at the time of the survey, and 229 (76.3%) were positive. Escherichia coli, Proteus mirabilis, Klebsiella spp, and Enterococcus spp represented 73.0% of all urine isolates (N = 278). There were 215 (77.3%) isolates with reported susceptibility data (Fig. 1). Of these, data were analyzed for 187 (87.0%) (Fig. 2). All isolates tested for carbapenems were susceptible. Fluoroquinolone non-susceptibility was most prevalent among E. coli (42.9%) and P. mirabilis (55.9%). Among Klebsiella spp, the highest percentages of non-susceptibility were observed for extended-spectrum cephalosporins and folate pathway inhibitors (25.0% each). Glycopeptide non-susceptibility was 10.0% for Enterococcus spp. The percentage of isolates classified as MDR ranged from 10.1% for E. coli to 14.7% for P. mirabilis. Conclusions: Substantial levels of non-susceptibility were observed for nursing home residents’ urine isolates, with 10% to 56% reported as non-susceptible to the antibiotics assessed. Non-susceptibility was highest for fluoroquinolones, an antibiotic class commonly used in nursing homes, and ≥ 10% of selected isolates were MDR. Our findings reinforce the importance of nursing homes using susceptibility data from laboratory service providers to guide antibiotic prescribing and to monitor levels of resistance.Disclosures: NoneFunding: None

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Antimicrobial Stewardship Interventions to Optimize Treatment of Infections in Nursing Home Residents: A Systematic Review and Meta-Analysis

Journal of Applied Gerontology ◽

10.1177/07334648211018299 ◽

2021 ◽

pp. 073346482110182

Author(s):

Sainfer Aliyu ◽

Jasmine L. Travers ◽

S. Layla Heimlich ◽

Joanne Ifill ◽

Arlene Smaldone

Keyword(s):

Systematic Review ◽

Nursing Home ◽

Antibiotic Stewardship ◽

Meta Analysis ◽

Nursing Home Residents ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Stewardship Program ◽

Meta Analyses

Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988–2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran’s Q = 166,837.8, p < .001, I2 = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.

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Prescribers’ Knowledge, Attitudes and Behaviors on Antibiotics, Antibiotic Use and Antibiotic Resistance in Jordan

Antibiotics ◽

10.3390/antibiotics10070858 ◽

2021 ◽

Vol 10 (7) ◽

pp. 858

Author(s):

Reema A. Karasneh ◽

Sayer I. Al-Azzam ◽

Mera Ababneh ◽

Ola Al-Azzeh ◽

Ola B. Al-Batayneh ◽

...

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Online Questionnaire ◽

Cross Sectional ◽

Attitudes And Behaviors ◽

And Behaviors ◽

Ease Of Access

More research is needed on the drivers of irrational antibiotic prescribing among healthcare professionals and to ensure effective prescribing and an adequate understanding of the issue of antibiotic resistance. This study aimed at evaluating prescribers’ knowledge, attitudes and behaviors about antibiotic use and antibiotic resistance. A cross-sectional study was conducted utilizing an online questionnaire and included physicians and dentists from all sectors in Jordan. A total of 613 prescribers were included (physicians n = 409, dentists n = 204). Respondents’ knowledge on effective use, unnecessary use or associated side effects of antibiotics was high (>90%), compared with their knowledge on the spread of antibiotic resistance (62.2%). For ease of access to the required guidelines on managing infections, and to materials that advise on prudent antibiotic use and antibiotic resistance, prescribers agreed in 62% and 46.1% of cases, respectively. 28.4% of respondents had prescribed antibiotics when they would have preferred not to do so more than once a day or more than once a week. Among respondents who prescribed antibiotics, 63.4% would never or rarely give out resources on prudent use of antibiotics for infections. The findings are of importance to inform antibiotic stewardships about relevant interventions aimed at changing prescribers’ behaviors and improving antibiotic prescribing practices.

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2051. Frequency of Inappropriate Antibiotic Prescribing in Nursing Homes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1731 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S691-S691

Author(s):

Chitra Kanchagar ◽

Brie N Noble ◽

Christopher Crnich ◽

Jessina C McGregor ◽

David T Bearden ◽

...

Keyword(s):

Nursing Homes ◽

Tract Infection ◽

Multidrug Resistant ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Term Care ◽

Antibiotic Overuse ◽

For Profit ◽

Memory Care ◽

Minimum Criteria

Abstract Background Antibiotics are among the most prescribed medications in nursing homes (NHs). The increasing incidence of multidrug-resistant and C. Difficile infections due to antibiotic overuse has driven the requirement for NHs to establish antibiotic stewardship programs (ASPs). However, estimates of the frequency of inappropriate antibiotic prescribing in NHs have varied considerably between studies. We evaluated the frequency of inappropriate antibiotic prescribing in a multi-state sample of NHs. Methods We utilized a retrospective, (20%) random sample of residents of 17 for-profit NHs in Oregon, California, and Nevada who received antibiotics between January 1, 2017 and May 31, 2018. Study NHs ranged in size from 50 to 188 beds and offered services including subacute care, long-term care, ventilator care, and Alzheimer’s/memory care. Data were collected from residents’ electronic medical records. Antibiotic appropriateness was defined using Loeb Minimum Criteria for initiation of antibiotics for residents with indications for lower respiratory tract infection (LRTI), urinary tract infection (UTI) and skin and soft-tissue infection (SSTI). Residents with other types of infections were excluded from the study. Results Among 232 antibiotic prescriptions reviewed, 61% (141/232) were initiated in the NH. Of these, 65% were for female residents and 81% were for residents above the age of 65. Nearly 70% (98/141) of antibiotic prescriptions were for an indication of an LRTI, UTI, or SSTI of which 51% (57% of LRTIs, 52% of UTIs, and 35% of SSTIs) did not meet the Loeb Minimum Criteria and were determined to be inappropriate. Among antibiotics that did not meet the Loeb Minimum Criteria, more than half were cephalosporins (40%) or fluoroquinolones (14%) and the median (interquartile range) duration of therapy was 7 (5–10) days. Conclusion These data from a multi-state sample of NHs suggest the continued need for improvement in antibiotic prescribing practices and the importance of ASPs in NHs. Disclosures All authors: No reported disclosures.

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Antibiotic prescribing practices within a Scottish acute medical admissions unit

Journal of Infection ◽

10.1016/j.jinf.2007.04.118 ◽

2007 ◽

Vol 55 (3) ◽

pp. e81

Author(s):

S.C. Dawson ◽

Y. Kumarasamy ◽

C. McGoldrick ◽

R.B.S. Laing

Keyword(s):

Antibiotic Prescribing ◽

Prescribing Practices

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