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CIDRAP- Antibiotic overprescribing; MRSA and diabetic foot infections

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  • CIDRAP- Antibiotic overprescribing; MRSA and diabetic foot infections

    Source: http://www.cidrap.umn.edu/news-persp...an-aug-25-2016


    Antimicrobial Resistance Scan for Aug 25, 2016
    Antibiotic overprescribing; MRSA and diabetic foot infections

    Filed Under:
    Antimicrobial Stewardship; MRSA
    Most adults with bronchitis receive unnecessary antibiotics

    A new study from the Centers for Disease Control and Prevention (CDC) has found that more than three quarters of adults diagnosed as having bronchitis receive an antibiotic, despite the fact that antibiotics are not indicated for the condition.
    The study, published in the American Journal of Managed Care, analyzed three measures related to antibiotic prescribing from the Healthcare Effectiveness Data and Information Set (HEDIS), a tool used by more than 90% of the nation's health plans to evaluate performance on important dimensions of care. Two of the measures focused on the pediatric population (appropriate testing for pharyngitis and appropriate treatment for upper respiratory infections), and the third measured avoidance of antibiotics in adults with acute bronchitis.
    The researchers examined data for the years 2008 to 2012, and the data set included only commercial health plans. For each measure, a higher percentage indicated a better performance.
    The results indicated that health plans generally performed well on the first two measures, with an average of 77% performing appropriate testing for pharyngitis and 84% treating upper respiratory infections in children appropriately (without antibiotics).
    But only 24% avoided antibiotic treatment for adults with bronchitis. And that number grew worse over time. In 2008, 26.6% of health plans avoided prescribing antibiotics for bronchitis; in 2012 antibiotic avoidance for adults with bronchitis was 22.7%. The authors concluded that interventions to improve antibiotic use should target providers who treat adults.
    Geographic variations in health plan performance were observed as well, with health plans in southern states generally having lower scores than other parts of the country on all three measures. But health plans in New England had the lowest score (21.9%) when it came to avoiding antibiotic treatment for adults with bronchitis.
    "Though drastic improvement is needed in the South, the data suggests that there are opportunities to improve antibiotic prescribing across the United States," Lauri Hicks, DO, co-author of the study and director of the CDC's Office of Antibiotic Stewardship, said in a statement.
    Aug 17 Am J Manag Care study

    Prevalence of MRSA in diabetic foot infections low, but antibiotic use high

    A study yesterday suggests that antibiotic therapy targeted against methicillin-resistant Staphylococcus aureus (MRSA) may be overused in patients with diabetic foot infections (DFIs).
    The study, published in PLoS One, included 318 patients treated at a Texas hospital from 2010 to 2014 for diagnosed DFIs, the leading cause of non-traumatic lower extremity amputations in the United States.
    Because limited data exist to support the recommendation that DFI patients with associated risk factors be treated with antimicrobials active against MRSA, the researchers wanted to determine prevalence of MRSA DFIs at the institution and compare that with the proportion of patients who received MRSA antibiotic coverage. They also wanted to identify risk factors for MRSA DFI.
    What the researchers found was that while S aureus was present in 46% of culture-positive DFIs, MRSA was present in only 15% of the infections. Yet 86% (273) of the DFI patients received MRSA antibiotic coverage, resulting in 71% unnecessary use. In a multivariable analysis, male gender and bone involvement were found to be independent risk factors for MRSA in DFIs.
    The authors said knowledge of MRSA prevalence in DFI patients, as well as the factors that might make certain patients more likely to be infected by MRSA, could help guide clinician decision-making and aid in antimicrobial stewardship efforts. They also called for larger epidemiologic investigations.
    Aug 24 PLoS One study



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