An analysis of antibiotic prescribing practices for enteric bacterial infections within FoodNet Canada sentinel sites

2020 ◽  
Vol 75 (4) ◽  
pp. 1061-1067
Author(s):  
Brendan Dougherty ◽  
Rita Finley ◽  
Barbara Marshall ◽  
Danielle Dumoulin ◽  
Amy Pavletic ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Treatment Guidelines ◽  
Descriptive Analysis ◽  
Antibiotic Use ◽  
Sentinel Site ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Environmental Scan ◽  
Current State ◽  
Enteric Infections

Abstract Objectives Understanding the current state of antibiotic treatment guidelines and prescribing practices for bacterial enteric infections is critical to inform antibiotic stewardship initiatives. This study aims to add to the current understanding through three objectives: (i) to identify and summarize published treatment guidelines for bacterial enteric infections; (ii) to describe observed antibiotic prescribing practices for bacterial enteric infections across three sentinel sites in Canada; and (iii) to assess concordance between observed antibiotic prescribing and treatment guidelines. Methods An environmental scan of treatment guidelines for bacterial enteric infections was conducted and recommendations were collated. A descriptive analysis of cases of bacterial enteric illnesses captured in FoodNet Canada’s sentinel site surveillance system between 2010 and 2018 was performed. Antibiotic-use data were self-reported by cases via an enhanced questionnaire. Results Ten treatment guidelines were identified in the environmental scan. There was substantial variation between guidelines for both when to prescribe antibiotics and which antibiotics were recommended. Of the 5877 cases of laboratory-confirmed bacterial enteric illness in the three sites, 49% of cases reported having received an antibiotic prescription. Of particular significance was the finding that 21% of verotoxigenic Escherichia coli cases received a prescription. Of the 17 antibiotics recommended in the guidelines, 14 were used in practice. In addition to these, 18 other antibiotics not included in any of the guidelines reviewed were also prescribed. Conclusions Our study suggests that a substantial proportion of enteric bacterial infections in Canada are prescribed antibiotics. These findings highlight the need to standardize treatment guidelines for enteric illnesses and could be used to inform future stewardship programme development.

scholarly journals 77. Antimicrobial Prescribing Practices for Enteric Bacterial Infections in an Integrated Rural Healthcare System, 2004–2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S2-S2
Author(s):  
Scott C Olson ◽  
Louise Francois Watkins ◽  
Louise Francois Watkins ◽  
Elaine Scallan Walter ◽  
Cindy R Friedman ◽  
...  
Keyword(s):  
Healthcare System ◽  
Practice Guidelines ◽  
Bacterial Infections ◽  
Patient Characteristics ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Gastrointestinal Infections ◽  
Appropriate Treatment ◽  
Enteric Infections

Abstract Background Bacterial enteric infections are common in the United States, but few studies have evaluated antibiotic prescribing practices for these illnesses. Unnecessary antibiotics can lead to adverse events and emergence of antimicrobial resistance. We assessed treatment practices among patients with laboratory-confirmed enteric infections in a large regional healthcare system. Methods We used electronic health records to identify patients with laboratory-confirmed nontyphoidal Salmonella, Shigella, Shiga toxin-producing E. coli (STEC), and Campylobacter infections from 2004 to 2017. We extracted relevant clinical data, including diagnosis codes for chronic conditions and receipt of immunosuppressive medications in the 60 days before and after the encounter, and antibiotic prescriptions in the 14 days after the encounter. We defined an appropriate treatment based on pathogen, patient characteristics, and IDSA practice guidelines for the study period. Results We identified 2,064 patients infected with enteric pathogens: 1,251 (61%) with Campylobacter, 564 (27%) Salmonella, 199 (10%) STEC, and 50 (2%) Shigella. Overall, 425 (20%) patients were immunocompromised, ranging from 17% for Salmonella to 46% for STEC. There were 220 (11%) hospitalizations. The frequency of antibiotic prescribing was highest for Campylobacter (60%), followed by Shigella (50%) and Salmonella (49%). Prescriptions were appropriate for 62% of Campylobacter cases, 92% of Shigella, and 70% of Salmonella. Antibiotics were prescribed for 39% of STEC infections although they are generally not indicated. Appropriate treatment was highest for children with Campylobacter (87%) and lowest for adults ≥50 years with Campylobacter (42%). Among those with Salmonella, appropriate treatment was higher in those with a comorbidity (79% vs. 68% without, P < 0.05). Rates of appropriate use did not improve over time. Conclusion Antibiotic prescribing for laboratory-confirmed enteric infections was frequently inappropriate and inconsistent with practice guidelines. Antibiotic stewardship initiatives should address acute bacterial gastrointestinal infections in addition to other common infections. Disclosures All Authors: No reported Disclosures.

scholarly journals 1082. Hold the Phone: Antibiotic Prescribing Practices Associated with Nonvisit Encounters for Urinary Tract Infections (UTIs) in Urology Clinics

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S384-S384
Author(s):  
Nina Akbar ◽  
Erica L Dobson ◽  
Michael Keefer ◽  
Sonal Munsiff ◽  
Ghinwa Dumyati
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Treatment Guidelines ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Medical Provider ◽  
Tract Infections

Abstract Background Surveillance data uncovers a high proportion of multidrug-resistant Gram-negative organisms found in the outpatient setting, often in patients with recurrent urinary tract infections (UTIs), underlying urologic abnormalities, and prior treatment for UTIs. We assessed prescribing practices at urology clinics to identify potential stewardship strategies for UTI management. Methods Antibiotic prescription encounters for adult patients from nine urology clinics were obtained from July to September 2018 using the EHR. We collected encounter types (visit or nonvisit), ordering medical provider types, antibiotic classes and patient demographics. A subset of 50 randomized, unique patient telephone encounters (TEs) was reviewed for documentation of a UTI diagnosis, symptoms, urinalysis and culture results, antibiotic prescriptions and duration. Results A total of 1,704 antibiotic orders were identified for 1,210 patients (48% female, median age 69 years, IQR 20). The majority (75%) of antibiotic encounters were from nonvisits: TEs (39%), orders only (25%), refills (9%), and patient email (2%). Major prescribers were advanced practice providers (APPs, 61%) followed by attending physicians (38%). Antibiotics prescribed were fluoroquinolones (FQs, 27%), nitrofurantoin (24%), first-generation cephalosporins (16%), and trimethoprim–sulfamethoxazole (15%). From the subset of 50 TEs, APPs wrote 76% of prescriptions and 32% of all orders were FQs. Thirty-nine patients had a clinical UTI diagnosis, yet 33% (13/39) did not have documentation of at least one urinary sign or symptom. For symptomatic patients, 15% (4/26) did not have a urine culture result within one week before or after the TE date. The distribution of antibiotics prescribed was similar to overall use and the median duration was 7 days. Conclusion Urology practices care for patients with the most complicated urinary tract pathology and appropriate antibiotic use in this population is a challenge. We found that urology providers often prescribe antibiotics to elderly patients without in-person visits, documentation of symptoms or microbiologic evidence of a UTI. Stewardship efforts should involve APPs, developing diagnostic and treatment guidelines for UTIs and improving documentation for antibiotic orders. Disclosures All authors: No reported disclosures.

scholarly journals Effects of an Antibiotic Cycling Program on Antibiotic Prescribing Practices in an Intensive Care Unit

2004 ◽  
Vol 48 (8) ◽  
pp. 2861-2865 ◽  
Author(s):  
Liana R. Merz ◽  
David K. Warren ◽  
Marin H. Kollef ◽  
Victoria J. Fraser
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bacterial Infections ◽  
Severity Of Illness ◽  
Empirical Therapy ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Successful Implementation ◽  
Prescribing Practices ◽  
Antibiotic Cycling

ABSTRACT Various interventions have been proposed to combat the increase of antibiotic resistance and influence antibiotic prescribing practices. A prospective cohort study in a medical intensive care unit was conducted to determine the effect of an antibiotic cycling program on patterns of antibiotic use and to determine patient factors associated with cycling adherence. Four major classes of antibiotics for empirical therapy of suspected gram-negative bacterial infections were rotated at 3- and 4-month intervals. During the study, 1,003 patients received antibiotic therapy with at least one of the study drugs; of the 792 receiving cycle antibiotics during the cycling period, 598 (75.5%) received an on-cycle drug. Compared to the baseline, cycling recommendations increased the use of the target cycle agent: the use of cephalosporins increased during cycle 1 (56 to 64% of total antibiotic days, P < 0.001), fluoroquinolone use increased in cycle 2 (24 to 55%, P < 0.001), carbapenem use increased during cycle 3 (14 to 38%, P < 0.001), and use of extended-spectrum penicillins increased in cycle 4 (5 to 36%, P < 0.001). Overall, 48% of total cycle antibiotic days were compliant with the cycling protocol. On average, 8.8 days per patient were spent receiving on-cycle drugs (range, 1 to 109). Cycle periods that specified carbapenem and fluoroquinolone use had the highest number of off-cycle days (62 and 64%). Predictors of on-cycle antibiotic use were increased severity of illness, as measured by an acute physiology and chronic health evaluation II score, and greater length of intensive care unit stay. In conclusion, the successful implementation of this cycling protocol increased antibiotic heterogeneity over time in the study unit.

scholarly journals An Evaluation of Antibiotic Prescribing Practices in a Rural Refugee Settlement District in Uganda

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 172
Author(s):  
Matua Bonniface ◽  
Winnie Nambatya ◽  
Kalidi Rajab
Keyword(s):  
Treatment Guidelines ◽  
Inappropriate Prescribing ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
World Health ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
National Treatment ◽  
Cross Sectional

Ensuring access to effective antibiotics and rational prescribing of antibiotics are critical in reducing antibiotic resistance. In this study, we evaluated antibiotic prescribing practices in a rural district in Uganda. It was a cross-sectional study that involved a retrospective review of 500 outpatient prescriptions from five health facilities. The prescriptions were systematically sampled. World Health Organization core medicine use prescribing and facility indicators were used. Percentage of encounters with one or more antibiotics prescribed was 23% (10,402/45,160). The mean number of antibiotics per prescription was 1.3 (669/500). About 27% (133/500) of the diagnoses and 42% (155/367) of the prescriptions were noncompliant with the national treatment guidelines. Prescribing antibiotics for nonbacterial infections such as malaria 32% (50/156) and noninfectious conditions such as dysmenorrhea and lumbago 15% (23/156) and nonspecific diagnosis such as respiratory tract infection 40% (59/133) were considered noncompliant with the guidelines. On average, 68% (51/75) of the antibiotics were available on the day of the visit. Inappropriate prescribing practices included excessive use of antibiotics and failure to diagnose and prescribe in compliance with treatment guidelines. There is a need to strengthen antibiotic use in the health facilities through setting up stewardship programs and interventions to promote adherence to national treatment guidelines.

A retrospective audit of antibiotic prescriptions in a Lebanese Hospital

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.

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

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.

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

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.

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

Antibiotics ◽  
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.

scholarly journals Antibiotic prescribing practices in three neonatology units in Kigali, Rwanda. – an observational study

2020 ◽  
Vol 20 (4) ◽  
pp. 1646-54
Author(s):  
Peter Thomas Cartledge ◽  
Fidel Shofel Ruzibuka ◽  
Florent Rutagarama ◽  
Samuel Rutare ◽  
Tanya Rogo
Keyword(s):  
Risk Factors ◽  
Median Duration ◽  
Neonatal Sepsis ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Second Line ◽  
Prescribing Practices ◽  
Urban District ◽  
Membrane Rupture ◽  
Significant Difference

Introduction: There is limited published data on antibiotic use in neonatal units in resource-poor settings. Objectives: This study sought to describe antibiotic prescribing practices in three neonatology units in Kigali, Rwanda. Methods: A multi-center, cross-sectional study conducted in two tertiary and one urban district hospital in Kigali, Rwan- da. Participants were neonates admitted in neonatology who received a course of antibiotics during their admission. Data collected included risk factors for neonatal sepsis, clinical signs, symptoms, investigations for neonatal sepsis, antibiotics prescribed, and the number of deaths in the included cohort. Results: 126 neonates were enrolled with 42 from each site. Prematurity (38%) followed by membrane rupture more than 18 hours (25%) were the main risk factors for neonatal sepsis. Ampicillin and Gentamicin (85%) were the most commonly used first-line antibiotics for suspected neonatal sepsis. Most neonates (87%) did not receive a second-line antibiotic. Cefotaxime (11%), was the most commonly used second-line antibiotic. The median duration of antibiotic use was four days in all sur- viving neonates (m=113). In neonates with negative blood culture and normal C-reactive protein (CRP), the median duration of antibiotics was 3.5 days; and for neonates, with positive blood cultures, the median duration was 11 days. Thirteen infants died (10%) at all three sites, with no significant difference between the sites. Conclusion: The median antibiotic duration for neonates with normal lab results exceeded the recommended duration mandated by the national neonatal protocol. We recommend the development of antibiotic stewardship programs in neo- natal units in Rwanda to prevent the adverse effects which may be caused by inappropriate or excessive use of antibiotics. Keywords: (MeSH): Antimicrobial stewardship; anti-bacterial agents; neonatal sepsis; sepsis; infant mortality; neonatal intensive care units; Africa; Rwanda.

scholarly journals An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections

2018 ◽  
Vol 5 (9) ◽  
Author(s):  
Michael J Durkin ◽  
Matthew Keller ◽  
Anne M Butler ◽  
Jennie H Kwon ◽  
Erik R Dubberke ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antibiotic Use ◽  
Emergency Department Visits ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Duration Of Treatment ◽  
Minimal Impact ◽  
Tract Infections ◽  
The Impact

Abstract Background In 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). Recommendations from this CPG were rapidly disseminated to clinicians via review articles, UpToDate, and the Centers for Disease Control and Prevention website; however, it is unclear if this CPG had an impact on national antibiotic prescribing practices. Methods We performed a retrospective cohort study of outpatient and emergency department visits within a commercial insurance database between January 1, 2009, and December 31, 2013. We included nonpregnant women aged 18–44 years who had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a UTI with a concurrent antibiotic prescription. We performed interrupted time series analyses to determine the impact of the CPG on the appropriateness of the antibiotic agent and duration. Results We identified 654 432 women diagnosed with UTI. The patient population was young (mean age, 31 years) and had few comorbidities. Fluoroquinolones, nonfirstline agents, were the most commonly prescribed antibiotic class both before and after release of the guidelines (45% vs 42%). Wide variation was observed in the duration of treatment, with &gt;75% of prescriptions written for nonrecommended treatment durations. The CPG had minimal impact on antibiotic prescribing behavior by providers. Conclusions Inappropriate antibiotic prescribing is common for the treatment of UTIs. The CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs. Further interventions are necessary to improve outpatient antibiotic prescribing for UTIs.

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