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Assessment of Rapid-Blood-Culture-Identification Result Interpretation and Antibiotic Prescribing Practices.

ABSTRACT: Rapid pathogen identification can alter antibiotic prescribing practices if interpreted correctly. Microbiology reporting can be difficult to understand, and new technology has made it more challenging. Nebraska Medicine recently implemented the BioFire FilmArray blood culture identification panel (BCID) coupled with stewardship-based education on interpretation. Physician BCID result interpretation and prescribing were assessed via an electronic survey, with a response rate of 40.8% (156/382 surveys). Seven questions required respondents to interpret BCID results, identify the most likely pathogen, and then choose therapy based on the results. The tallied correct responses resulted in a knowledge score. General linear models evaluated the effect of role, specialty, and utilization of the BCID interpretation guide on the mean knowledge score. The specialties of the respondents included 55.7% internal medicine, 19.7% family medicine, and 24.6% other. Roles included 41.1% residents, 5.0% fellows, and 53.9% faculty. Most reported that they reviewed antimicrobial susceptibility results (89.4%) and adjusted therapy accordingly (81.6%), while only 60% stated that they adjusted therapy based on BCID results. The correct response rates ranged from 52 to 86% for the interpretation questions. The most common errors included misinterpretation of Enterobacteriaceae and Staphylococcus genus results. Neither role nor specialty was associated with total knowledge score in multivariate analysis (P = 0.13 and 0.47, respectively). In conclusion, physician interpretation of BCID results is suboptimal and can result in ineffective treatment or missed opportunity to narrow therapy. With the implementation of new technology, improved reporting practices of BCID results with clinical decision support tools providing interpretation guidance available at the point of care is recommended.

SUBMITTER: Donner LM

PROVIDER: S-EPMC5405267 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Assessment of Rapid-Blood-Culture-Identification Result Interpretation and Antibiotic Prescribing Practices.

Donner Linsey M LM Campbell W Scott WS Lyden Elizabeth E Van Schooneveld Trevor C TC

Journal of clinical microbiology 20170301 5

Rapid pathogen identification can alter antibiotic prescribing practices if interpreted correctly. Microbiology reporting can be difficult to understand, and new technology has made it more challenging. Nebraska Medicine recently implemented the BioFire FilmArray blood culture identification panel (BCID) coupled with stewardship-based education on interpretation. Physician BCID result interpretation and prescribing were assessed via an electronic survey, with a response rate of 40.8% (156/382 su ...[more]

PMID: 28250000

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Project description:ObjectiveThe indiscriminate prescription of antibiotics has led to the emergence of resistance microbes worldwide. This study aimed to investigate the antibiotic prescribing practices amongst general dental practitioners and specialists in managing endodontic infections in the United Arab Emirates (UAE).DesignGeneral dental practitioners and specialists in the UAE were invited to participate in an online questionnaire survey which included questions on socio-demographics, practitioner's antibiotic prescribing preferences for various pulpal and periapical diseases, and their choice, in terms of the type, dose and duration of the antibiotic. The link to the survey questionnaire was sent to 250 invited dentists. Data were analyzed by descriptive statistics and chi-square tests for independence and level of significance was set at 0.05.ResultsA total of 174 respondents participated in the survey (response rate = 70%). The respondents who prescribed antibiotics at least once a month were 38.5% while 17.2% did so, more than three times a week; amoxicillin 500 mg was the antibiotic of choice for patients not allergic to penicillin (43.7%), and in cases of penicillin allergies, erythromycin 500 mg (21.3%). There was a significant difference in the antibiotic prescribing practices of GDPs compared to endodontists and other specialties especially in clinical cases such as acute apical abscesses with swelling and moderate to severe pre-operative symptoms and retreatment of endodontic cases (p<0.05). Approximately, three quarters of the respondents (78.7%) did not prescribe a loading dose when prescribing antibiotics. About 15% respondents prescribed antibiotics to their patients if they were not accessible to patients due to a holiday/weekend.ConclusionsIn general, the antibiotic prescribing practices of UAE dentists are congruent with the international norms. However, there were occasions of inappropriate prescriptions such as in patients with irreversible pulpitis, necrotic pulps with no systemic involvement and/or with sinus tracts.

Project description:BackgroundTrials 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.MethodsThis 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.ResultsNine 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.ConclusionsHigh-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.

Dataset Information

Assessment of Rapid-Blood-Culture-Identification Result Interpretation and Antibiotic Prescribing Practices.

Publications

Assessment of Rapid-Blood-Culture-Identification Result Interpretation and Antibiotic Prescribing Practices.

Similar Datasets

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