Antibiotic-Stewardship Practices at Top Academic Centers Throughout the United States and at Hospitals Throughout Massachusetts

2006 ◽  
Vol 27 (7) ◽  
pp. 695-703 ◽  
Author(s):  
Tamar F. Barlam ◽  
Margarita DiVall
Keyword(s):  
United States ◽  
Antibiotic Stewardship ◽  
Bacterial Resistance ◽  
Hospital Costs ◽  
Geographic Area ◽  
The United States ◽  
Teaching Hospitals ◽  
Antibiotic Prescribing ◽  
Community Hospitals ◽  
Management Interventions

Objective.Improvements in antibiotic prescribing to reduce bacterial resistance and control hospital costs is a growing priority, but the way to accomplish this is poorly defined. Our goal was to determine whether certain antibiotic stewardship interventions were universally instituted and accepted at top US academic centers and to document what interventions, if any, are used at both teaching and community hospitals within a geographic area.Design.Two surveys were conducted. In survey 1, detailed phone interviews were performed with the directors of antibiotic stewardship programs at 22 academic medical centers that are considered among the best for overall medical care in the United States or as leaders in antibiotic stewardship programs. In survey 2, teaching and community hospitals throughout Massachusetts were surveyed to ascertain what antibiotic oversight program components were present.Results.In survey 1, each of the 22 participating hospitals had instituted interventions to improve antibiotic prescribing, but none of the interventions were universally accepted as essential or effective. In survey 2, of 97 surveys that were mailed to prospective participants, a total of 54 surveys from 19 teaching hospitals and 35 community hospitals were returned. Ninety-five percent of the teaching hospitals had a restricted formulary, compared with 49% of the community hospitals, and 89% of teaching hospitals had an antibiotic approval process, compared with 29% of community hospitals.Conclusion.There was great variability among the approaches to the oversight of antibiotic prescribing at major academic hospitals. Antibiotic management interventions were lacking in more than half of the Massachusetts community hospitals surveyed. More research is needed to define the best antibiotic stewardship interventions for different hospital settings.

scholarly journals Clinical impact of pharmacist-led antibiotic stewardship programs in outpatient settings in the United States: A scoping review

2021 ◽  
Author(s):  
James St. Louis ◽  
Arinze Nkemdirim Okere
Keyword(s):  
United States ◽  
Usual Care ◽  
Antibiotic Stewardship ◽  
The United States ◽  
Controlled Trials ◽  
Antibiotic Prescribing ◽  
Successful Implementation ◽  
Pharmacist Interventions ◽  
Outpatient Settings ◽  
The Impact

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To provide an overview of the impact of pharmacist interventions on antibiotic prescribing and the resultant clinical outcomes in an outpatient antibiotic stewardship program (ASP) in the United States. Methods Reports on studies of pharmacist-led ASP interventions implemented in US outpatient settings published from January 2000 to November 2020 and indexed in PubMed or Google Scholar were included. Additionally, studies documented at the ClinicalTrials.gov website were evaluated. Study selection was based on predetermined inclusion criteria; only randomized controlled trials, observational studies, nonrandomized controlled trials, and case-control studies conducted in outpatient settings in the United States were included. The primary outcome was the observed differences in antibiotic prescribing or clinical benefits between pharmacist-led ASP interventions and usual care. Results Of the 196 studies retrieved for full-text review, a cumulative total of 15 studies were included for final evaluation. Upon analysis, we observed that there was no consistent methodology in the implementation of ASPs and, in most cases, the outcome of interest varied. Nonetheless, there was a trend toward improvement in antibiotic prescribing with pharmacist interventions in ASPs compared with that under usual care (P < 0.05). However, the results of these studies are not easily generalizable. Conclusion Our findings suggest a need for a consistent approach for the practical application of outpatient pharmacist-led ASPs. Managed care organizations could play a significant role in ensuring the successful implementation of pharmacist-led ASPs in outpatient settings.

scholarly journals Outpatient Macrolide Antibiotic Prescribing in the United States, 2008–2011

2017 ◽  
Vol 4 (4) ◽  
Author(s):  
Guillermo V Sanchez ◽  
Daniel J Shapiro ◽  
Adam L Hersh ◽  
Lauri A Hicks ◽  
Katherine E Fleming-Dutra
Keyword(s):  
United States ◽  
Medical Care ◽  
Survey Data ◽  
Antibiotic Stewardship ◽  
Macrolide Antibiotic ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Family Practitioners ◽  
Care Survey ◽  
Ambulatory Medical Care

Abstract National Ambulatory Medical Care Survey data were used to assess outpatient macrolide prescribing and selection. Conditions for which macrolides are firstline therapy represented 5% of macrolide prescribing. Family practitioners selected macrolides for children more frequently than pediatricians. Macrolides are an important antibiotic stewardship target.

scholarly journals Primary Care Physicians’ Attitudes and Perceptions Towards Antibiotic Resistance and Antibiotic Stewardship: A National Survey

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Rachel M Zetts ◽  
Andrea M Garcia ◽  
Jason N Doctor ◽  
Jeffrey S Gerber ◽  
Jeffrey A Linder ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Antibiotic Resistance ◽  
Antibiotic Stewardship ◽  
Primary Care Physicians ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Vaccine Hesitancy ◽  
Resistant Bacteria ◽  
Antibiotic Prescribing

Abstract Background Outpatient antibiotic stewardship is needed to reduce inappropriate prescribing and minimize the development of resistant bacteria. We assessed primary care physicians’ perceptions of antibiotic resistance, antibiotic use, and the need for stewardship activities. Methods We conducted a national online survey of 1550 internal, family, and pediatric medicine physicians in the United States recruited from an opt-in panel of healthcare professionals. Descriptive statistics were generated for respondent demographics and question responses. Responses were also stratified by geographic region and medical specialty, with a χ 2 test used to assess for differences. Results More respondents agreed that antibiotic resistance was a problem in the United States (94%) than in their practice (55%) and that inappropriate antibiotic prescribing was a problem in outpatient settings (91%) than in their practice (37%). In addition, 60% agreed that they prescribed antibiotics more appropriately than their peers. Most respondents (91%) believed that antibiotic stewardship was appropriate in office-based practices, but they ranked antibiotic resistance as less important than other public health issues such as obesity, diabetes, opioids, smoking, and vaccine hesitancy. Approximately half (47%) believed they would need a lot of help to implement stewardship. Respondents indicated that they were likely to implement antibiotic stewardship efforts in response to feedback or incentives provided by payers or health departments. Conclusions Primary care physicians generally did not recognize antibiotic resistance and inappropriate prescribing as issues in their practice. This poses a challenge for the success of outpatient stewardship. Healthcare stakeholders will need to explore opportunities for feedback and incentive activities to encourage stewardship uptake.

scholarly journals Patterns of dental antibiotic prescribing in 2017: Australia, England, United States, and British Columbia (Canada)

2021 ◽  
pp. 1-8
Author(s):  
Wendy Thompson ◽  
Leanne Teoh ◽  
Colin C. Hubbard ◽  
Fawziah Marra ◽  
David M. Patrick ◽  
...  
Keyword(s):  
United States ◽  
British Columbia ◽  
Broad Spectrum ◽  
Antibiotic Prescription ◽  
Population Level ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Prescribing Behavior ◽  
The Us ◽  
Amoxicillin Clavulanic Acid

Abstract Objective: Our objective was to compare patterns of dental antibiotic prescribing in Australia, England, and North America (United States and British Columbia, Canada). Design: Population-level analysis of antibiotic prescription. Setting: Outpatient prescribing by dentists in 2017. Participants: Patients receiving an antibiotic dispensed by an outpatient pharmacy. Methods: Prescription-based rates adjusted by population were compared overall and by antibiotic class. Contingency tables assessed differences in the proportion of antibiotic class by country. Results: In 2017, dentists in the United States had the highest antibiotic prescribing rate per 1,000 population and Australia had the lowest rate. The penicillin class, particularly amoxicillin, was the most frequently prescribed for all countries. The second most common agents prescribed were clindamycin in the United States and British Columbia (Canada) and metronidazole in Australia and England. Broad-spectrum agents, amoxicillin-clavulanic acid, and azithromycin were the highest in Australia and the United States, respectively. Conclusion: Extreme differences exist in antibiotics prescribed by dentists in Australia, England, the United States, and British Columbia. The United States had twice the antibiotic prescription rate of Australia and the most frequently prescribed antibiotic in the US was clindamycin. Significant opportunities exist for the global dental community to update their prescribing behavior relating to second-line agents for penicillin allergic patients and to contribute to international efforts addressing antibiotic resistance. Patient safety improvements will result from optimizing dental antibiotic prescribing, especially for antibiotics associated with resistance (broad-spectrum agents) or C. difficile (clindamycin). Dental antibiotic stewardship programs are urgently needed worldwide.

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

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

scholarly journals 1686. Microbiology of Community-Onset Urinary Tract Infections in the United States, 2012-2017

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S826-S827
Author(s):  
Leigh Ellyn Preston ◽  
Clifford McDonald ◽  
Babatunde Olubajo ◽  
Natalie McCarthy ◽  
Sujan Reddy ◽  
...  
Keyword(s):  
United States ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Relative Frequency ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Factors Associated ◽  
Tract Infections ◽  
Community Onset

Abstract Background Community-onset urinary tract infections (coUTIs) are one of the most common indications for antibiotic prescribing. It is important to understand patient demographic factors associated with microorganisms causing coUTI and their antibiotic resistance profiles, to tailor antibiotic prescribing practices. We analyzed microbiology data to understand factors associated with coUTI in the United States (US). Methods CoUTIs were identified in the Premier Healthcare Database and Cerner Health Facts among patients treated at participating healthcare facilities in the US between 2012-2017. Cases were defined by urine cultures yielding a bacterial organism and were collected in outpatient settings or within three days of hospitalization. Only the first specimen for each encounter was included in the analysis. Data on the organisms isolated, patient’s age, sex, and US census regions of the submitting facilities were described and compared using chi-square tests for associations. Encounters were classified as inpatient (INPT), observation (OBS), emergency department (ED), and outpatient (OTPT) based on the setting in which the culture was submitted. Results Using data from 637 acute care hospitals, urine samples from 3,291,561 encounters were included, with 776,653 (25.7%) INPT, 1,063,219 (34.8%) ED, 107,760 (3.5%) OBS, and 1,092,658 (35.8%) OTPT. The pathogens most frequently associated with coUTIs were Escherichia coli (57.3%), Klebsiella pneumoniae (9.7%), Enterococcus faecalis (5.1%), Proteus mirabilis (4.9%), and Pseudomonas aeruginosa (2.9%). Female sex, age < 65y and OTPT and ED settings were associated with higher relative frequency of E. coli (all p < 0.0001). Male sex, INPT setting and age >65 y were associated with higher relative frequency of P. aeruginosa, P. mirabilis and E. faecalis (all p < 0.0001, Figure). K. pneumoniae was found at higher relative frequency in those >45y, and in INPT and OBS settings (all p < 0.0001). Figure. Distribution of pathogens most frequently associated with community onset urinary tract infections Conclusion Understanding patient factors associated with the microbiology of coUTIs is an important step in developing treatment recommendations and antibiotic stewardship efforts. Further analyses will include assessing the impact of major antibiotic resistance phenotypes, geographic and healthcare settings. Disclosures All Authors: No reported disclosures

The Diffusion of New Hospital Technologies in the United States

1976 ◽  
Vol 6 (4) ◽  
pp. 557-580 ◽  
Author(s):  
Louise B. Russell
Keyword(s):  
United States ◽  
Intensive Care ◽  
Hospital Care ◽  
Hospital Costs ◽  
The United States ◽  
Major Contributor ◽  
Certificate Of Need ◽  
Hospital Regulation ◽  
Resource Requirements ◽  
Competing Technologies

Increases in the real resources used in hospital care have been an important cause behind rising hospital costs in the United States. Many of these resources have taken the form of new hospital technologies, and this paper begins by reviewing the trends in adoption of new hospital technologies over the years 1950–1974. The resource requirements, costs, and to the extent possible the patient benefits, of two of these technologies are then discussed in more detail: intensive care, a widespread facility with many variations, has been a major contributor to hospital costs; radiotherapy has been characterized by a succession of competing technologies. Regulatory efforts such as certificate-of-need reviews would be more effective if they viewed hospitals as flexible collections of such technologies—with the costs and patient benefits of each to be weighed separately—rather than primarily in terms of numbers of beds. A national center to collect information on the separate technological functions of hospitals and make it available to interested groups would make a useful contribution to hospital regulation.

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