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Sustained Reduction in Urgent Care Antibiotic Prescribing During the Coronavirus Disease 2019 Pandemic: An Academic Medical Center's Experience.

ABSTRACT: We compared antibiotic prescribing before and during the -coronavirus disease 2019 (COVID-19) pandemic at 2 academic urgent care clinics and found a sustained decrease in prescribing driven by respiratory encounters and despite transitioning to telemedicine. Antibiotics were rarely prescribed during encounters for COVID-19 or COVID-19 symptoms. COVID-19 revealed opportunities for outpatient stewardship programs.

SUBMITTER: Ha D

PROVIDER: S-EPMC8802794 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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Sustained Reduction in Urgent Care Antibiotic Prescribing During the Coronavirus Disease 2019 Pandemic: An Academic Medical Center's Experience.

Ha David D Ong'uti Sharon S Chang Amy A Mui Emily E Nelligan Ian I Betts Brooke B Lentz Christopher C Alegria William W Fox Emily E Meng Lina L Stenehjem Edward E Hersh Adam L AL Deresinski Stanley S Artandi Maja M Holubar Marisa M

Open forum infectious diseases 20220122 2

We compared antibiotic prescribing before and during the -coronavirus disease 2019 (COVID-19) pandemic at 2 academic urgent care clinics and found a sustained decrease in prescribing driven by respiratory encounters and despite transitioning to telemedicine. Antibiotics were rarely prescribed during encounters for COVID-19 or COVID-19 symptoms. COVID-19 revealed opportunities for outpatient stewardship programs. ...[more]

PMID: 35111874

Similar Datasets

Validity of Coronavirus Disease 2019 <i>International Classification of Diseases, Tenth Revision</i> in the Urgent Care Setting and Impact on Antibiotic Prescribing Rates.

Project description:We validated different coronavirus disease 2019 (COVID-19) International Classification of Diseases, Tenth Edition (ICD-10) encounter definitions across 2 urgent care clinics. Sensitivity of definitions varied throughout the pandemic. Inclusion of COVID-19 and COVID-19-like illness (CLI) ICD-10s rendered highest sensitivity but lowest specificity. Antibiotic prescribing rates were low for COVID-19 ICD-10 encounters, increasing with CLI ICD-10 encounters.

| S-EPMC9897297 | biostudies-literature

Quality of antibiotic prescribing to children through the coronavirus disease 2019 (COVID-19) pandemic.

Project description:ObjectiveTo describe pediatric outpatient visits and antibiotic prescribing during the coronavirus disease 2019 (COVID-19) pandemic.DesignAn observational, retrospective control study from January 2019 to October 2021.SettingOutpatient clinics, including 27 family medicine clinics, 27 pediatric clinics, and 26 urgent or prompt care clinics.PatientsChildren aged 0-19 years receiving care in an outpatient setting.MethodsData were extracted from the electronic health record. The COVID-19 era was defined as April 1, 2020, to October 31, 2021. Virtual visits were identified by coded encounter or visit type variables. Visit diagnoses were assigned using a 3-tier classification system based on appropriateness of antibiotic prescribing and a subanalysis of respiratory visits was performed to compare changes in the COVID-19 era compared to baseline.ResultsThrough October 2021, we detected an overall sustained reduction of 18.2% in antibiotic prescribing to children. Disproportionate changes occurred in the percentages of antibiotic visits in respiratory visits for children by age, race or ethnicity, practice setting, and prescriber type. Virtual visits were minimal during the study period but did not result in higher rates of antibiotic visits or in-person follow-up visits.ConclusionsThese findings suggest that reductions in antibiotic prescribing have been sustained despite increases in outpatient visits. However, additional studies are warranted to better understand disproportionate rates of antibiotic visits.

| S-EPMC9726595 | biostudies-literature

Ventilatory Mechanics in Early vs Late Intubation in a Cohort of Coronavirus Disease 2019 Patients With ARDS: A Single Center's Experience.

Project description: Not available

| S-EPMC7456835 | biostudies-literature

Utilizing Behavioral Science to Improve Antibiotic Prescribing in Rural Urgent Care Settings.

Project description:BackgroundAntibiotic-inappropriate prescribing for acute respiratory tract infections (ARTI) is 45% among urgent care centers (UCCs) in the United States. Locally in our UCCs, antibiotic-inappropriate prescribing for ARTI is higher-over 70%.MethodsWe used a quasi-experimental design to implement 3 behavioral interventions targeting antibiotic-inappropriate/non-guideline-concordant prescribing for ARTI at 3 high-volume rural UCCs and analyzed prescribing rates pre- and post-intervention. The 3 interventions were (1) staff/patient education, (2) public commitment, and (3) peer comparison. For peer comparison, providers were sent feedback emails with their prescribing data during the intervention period and a blinded ranking email comparing them with their peers. Providers were categorized as "low prescribers" (ie, ≤23% antibiotic-inappropriate prescriptions based off the US National Action Plan for Combating Antibiotic Resistant Bacteria 2020 goal) or "high prescribers" (ie, ≥45%-the national average of antibiotic-inappropriate prescribing for ARTI). An interrupted time series (ITS) analysis compared prescribing for ARTI (the primary outcome) over a 16-month period before the intervention and during the 6-month intervention period, for a total of 22 months, across the 3 UCCs.ResultsFewer antibiotic-inappropriate prescriptions were written during the intervention period (57.7%) compared with the pre-intervention period (72.6%) in the 3 UCCs, resulting in a 14.9% absolute decrease in percentage of antibiotic-inappropriate prescriptions. The ITS analysis revealed that the rate of antibiotic-inappropriate prescribing was statistically significantly different pre-intervention compared with the intervention period (95% confidence interval, -4.59 to -0.59; P = .014).ConclusionsIn this sample of rural UCCs, we reduced antibiotic-inappropriate prescribing for ARTI using 3 behavioral interventions.

| S-EPMC7341903 | biostudies-literature

Rapid streptococcal pharyngitis testing and antibiotic prescribing before and during the coronavirus disease 2019 (COVID-19) pandemic.

Project description: Not available

| S-EPMC9726542 | biostudies-literature

National Trends in Antibiotic Prescribing for Adults Hospitalized With Coronavirus Disease 2019 and Other Viral Respiratory Infections.

Project description:BackgroundSignificant concerns have been raised regarding the overuse of antibiotics among patients hospitalized for coronavirus disease 2019 (COVID-19) and the broad impact of the pandemic on antimicrobial stewardship in acute care. We sought to compare potentially unnecessary antibiotic prescribing over time among patients admitted with symptomatic COVID-19 and non-COVID-19 viral acute respiratory tract infections (ARTIs).MethodsWe conducted a repeated cross-sectional analysis of the monthly antibiotic prescribing rate from March 2020 to December 2023 for COVID-19 admissions and from January 2019 to December 2023 for other viral ARTI admissions to 803 acute care hospitals in the United States that contributed data to the Premier Healthcare Database. Our primary outcome was the receipt of ≥1 dose of an antibiotic during the first 5 days of the admission. Secondary outcomes included days and duration of antibiotic therapy.ResultsThis study included 513 698 COVID-19 and 106 932 non-COVID-19 viral ARTI admissions from March 2020 to December 2023. At the onset of the pandemic, >80% of patients admitted for COVID-19 received antibiotics, and antibiotic prescribing for other viral ARTIs increased to nearly 70%. Antibiotic prescribing for these viral infections declined over time, with prescribing for COVID-19 stabilizing around 35% in 2022-2023 and prescribing for other viral ARTIs returning to 2019 seasonal patterns in 2023, with average monthly prescribing around 50%.ConclusionsDespite improvements since the early part of the COVID-19 pandemic, potentially unnecessary antibiotic prescribing for inpatients with COVID-19 and non-COVID-19 viral ARTIs remains an important antibiotic stewardship target.

| S-EPMC11832046 | biostudies-literature

Reduction in Antibiotic Prescribing Attainable With a Gonococcal Vaccine.

Project description:We estimated the fraction of antibiotic prescribing in the United States attributable to gonorrhea. Gonorrhea contributes to an outsized proportion of antibiotic prescriptions in young adults, males, and in the southern and western United States. A gonococcal vaccine could substantially reduce antibiotic prescribing in these populations.

| S-EPMC8522794 | biostudies-literature

A point prevalence survey to assess antibiotic prescribing in patients hospitalized with confirmed and suspected coronavirus disease 2019 (COVID-19).

Project description:BackgroundEarlier studies have reported high antibiotic use in patients hospitalised for coronavirus disease 2019 (COVID-19), resulting in concerns of increasing antimicrobial resistance with increase antibiotic use in this pandemic. Point prevalence survey (PPS) can be a quick tool to provide antibiotic prescribing information to aid antimicrobial stewardship (AMS) activities.ObjectivesTo describe antibiotic utilization and evaluate antibiotic appropriateness in COVID-19 patients using PPS.MethodsAdapting Global-PPS on antimicrobial use, the survey was conducted in COVID-19 wards at 2 centres in Singapore on 22 April 2020 at 0800h. Patients on systemic antibiotics were included and evaluated for antibiotic appropriateness.ResultsFive hundred and seventy-seven patients were screened. Thirty-six (6.2%) patients were on antibiotics and which were started at median of 7 days (inter-quartile rate (IQR), 4, 11) from symptom onset. Fifty-one antibiotics were prescribed in these patients. Overall, co-amoxiclav (26/51, 51.0%) was the most often prescribed antibiotic. Thirty-one out of 51 (60.8%) antibiotic prescriptions were appropriate. Among 20 inappropriate prescriptions, 18 (90.0%) were initiated in patients with low likelihood of bacterial infections. Antibiotic prescriptions were more appropriate when reviewed by infectious diseases physicians (13/31 [41.9%] versus 2/20 [10.0%], p=0.015), and if reasons for use were stated in notes (31/31 [100.0%] versus 16/20 [80.0%], p=0.019).ConclusionsDespite low prevalence of antibiotic use among confirmed and suspected COVID-19 patients at 2 centres in Singapore, there was significant proportion of inappropriate antibiotics use where bacterial infections were unlikely. AMS teams can tailor stewardship strategies using PPS results.

| S-EPMC7722492 | biostudies-literature

Beyond antibiotic prescribing rates: first-line antibiotic selection, prescription duration, and associated factors for respiratory encounters in urgent care.

Project description:ObjectiveAssess urgent care (UC) clinician prescribing practices and factors associated with first-line antibiotic selection and recommended duration of therapy for sinusitis, acute otitis media (AOM), and pharyngitis.DesignRetrospective cohort study.ParticipantsAll respiratory UC encounters and clinicians in the Intermountain Health (IH) network, July 1st, 2019-June 30th, 2020.MethodsDescriptive statistics were used to characterize first-line antibiotic selection rates and the duration of antibiotic prescriptions during pharyngitis, sinusitis, and AOM UC encounters. Patient and clinician characteristics were evaluated. System-specific guidelines recommended 5-10 days of penicillin, amoxicillin, or amoxicillin-clavulanate as first-line. Alternative therapies were recommended for penicillin allergy. Generalized estimating equation modeling was used to assess predictors of first-line antibiotic selection, prescription duration, and first-line antibiotic prescriptions for an appropriate duration.ResultsAmong encounters in which an antibiotic was prescribed, the rate of first-line antibiotic selection was 75%, the recommended duration was 70%, and the rate of first-line antibiotic selection for the recommended duration was 53%. AOM was associated with the highest rate of first-line prescriptions (83%); sinusitis the lowest (69%). Pharyngitis was associated with the highest rate of prescriptions for the recommended duration (91%); AOM the lowest (51%). Penicillin allergy was the strongest predictor of non-first-line selection (OR = 0.02, 95% CI [0.02, 0.02]) and was also associated with extended duration prescriptions (OR = 0.87 [0.80, 0.95]).ConclusionsFirst-line antibiotic selection and duration for respiratory UC encounters varied by diagnosis and patient characteristics. These areas can serve as a focus for ongoing stewardship efforts.

| S-EPMC10523551 | biostudies-literature

Antibiotic Prescribing Variability in a Large Urgent Care Network: A New Target for Outpatient Stewardship.

Project description:Improving antibiotic prescribing in outpatient settings is a public health priority. In the United States, urgent care (UC) encounters are increasing and have high rates of inappropriate antibiotic prescribing. Our objective was to characterize antibiotic prescribing practices during UC encounters, with a focus on respiratory tract conditions. This was a retrospective cohort study of UC encounters in the Intermountain Healthcare network. Among 1.16 million UC encounters, antibiotics were prescribed during 34% of UC encounters and respiratory conditions accounted for 61% of all antibiotics prescribed. Of respiratory encounters, 50% resulted in antibiotic prescriptions, yet the variability at the level of the provider ranged from 3% to 94%. Similar variability between providers was observed for respiratory conditions where antibiotics were not indicated and in first-line antibiotic selection for sinusitis, otitis media, and pharyngitis. These findings support the importance of developing antibiotic stewardship interventions specifically targeting UC settings.

| S-EPMC7768670 | biostudies-literature

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