Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2020/06/stewardship-resistance-scan-jun-08-2020
Stewardship / Resistance Scan for Jun 08, 2020
Antimicrobial stewardship in urgent care; Flu vaccine and antibiotic use
Filed Under:
Antimicrobial Stewardship; Influenza Vaccines
Behavioral interventions tied to less urgent care antibiotic use
Implementation of behavioral "nudges" targeting non–guideline-concordant antibiotic prescribing helped reduce inappropriate prescribing for respiratory tract infections at three California urgent care centers (UCCs), researchers reported last week in Open Forum Infectious Diseases.
The study by researchers from Eisenhower Health, the University of California-Davis, and the University of Southern California Keck School of Medicine looked at prescribing rates for acute respiratory tract infections (ARTIs) at the high-volume rural UCCs before and after the implementation of three behavioral interventions: physician/patient education, public commitment, and peer comparison. The peer comparison intervention involved sending individual prescribing data and a blinded ranking email to providers.
The interventions were based on work from the MITIGATE study, which found that stewardship interventions tailored to the local site and setting reduced antibiotic prescribing for ARTIs by a third. An interrupted time series analysis (ITS) compared prescribing for ARTIs at the urgent care centers over a 16-month period before the intervention and 6 months during the intervention, a period that covered two flu seasons.
The analysis found a lower percentage of antibiotic-inappropriate prescribing during the intervention-period (58.5%) flu season (2018-19) than during the pre–intervention-period (73%) flu season (2017-18), resulting in an absolute 14.5% decrease in inappropriate prescribing for ARTIs, or about 981 prescriptions averted. The ITS analysis revealed that the estimated mean percent of antibiotic-inappropriate prescribing for ARTI decreased by 2.2% per month during the intervention period, compared with –0.71% during the pre-intervention period.
"The observed decrease in antibiotic-inappropriate prescribing for ARTI in this study suggests that utilizing a behavioral science approach may improve judicious use of antibiotics in community UCCs," the authors concluded.
Jun 6 Open Forum Infect Dis abstract
Higher US flu vaccine coverage linked to lower antibiotic prescribing
In another new study in Open Forum Infectious Diseases, researchers from the Center for Disease Dynamics, Economics & Policy in Washington, DC, and the University of Maryland School of Medicine in Baltimore found that increased influenza vaccination uptake was associated with state-level reductions in antibiotic use.
Using state-level monthly data on the number of dispensed antibiotic prescriptions from a large prescription drug database and seasonal flu vaccination coverage data from the Centers for Disease Control and Prevention's FluVaxView database, the researchers conducted a retrospective analysis of US flu vaccination coverage and antibiotic prescribing rates from 2010 through 2017. They used a fixed-effects regression analysis to analyze the relationship between vaccine coverage rates and the number of antibiotic prescriptions per 1,000 residents from January to March of each year. They also looked at the impact of vaccination on prescribing by age-group.
After controlling for access to healthcare, socioeconomic differences, vaccine effectiveness, climate, and state-level differences, the researchers found a significant negative association between increased influenza vaccination rates and antibiotic use rates.
A ten-percentage point increase in vaccine coverage was associated with 6.5% reduction in prescription rates, equivalent to 14.2 fewer antibiotic prescriptions per 1,000 individuals (95% confidence interval [CI], 6.0 to 22.4, P = 0.001). Increased vaccination coverage reduced prescribing rates in the pediatric population (0 to 18 years) by 6.0% or 15.2 prescriptions per 1,000 individuals (95% CI, 9.0 to 21.3; P < 0.001), and in those over 65 years by 5.2% or 12.8 prescriptions per 1,000 individuals (95% CI, 6.5 to 19.2, P < 0.001).
"Substantially boosting seasonal influenza vaccination coverage should be a central element of efforts to reduce use of antibiotics," the authors of the study wrote.
Jun 6 Open Forum Infect Dis abstract
Stewardship / Resistance Scan for Jun 08, 2020
Antimicrobial stewardship in urgent care; Flu vaccine and antibiotic use
Filed Under:
Antimicrobial Stewardship; Influenza Vaccines
Behavioral interventions tied to less urgent care antibiotic use
Implementation of behavioral "nudges" targeting non–guideline-concordant antibiotic prescribing helped reduce inappropriate prescribing for respiratory tract infections at three California urgent care centers (UCCs), researchers reported last week in Open Forum Infectious Diseases.
The study by researchers from Eisenhower Health, the University of California-Davis, and the University of Southern California Keck School of Medicine looked at prescribing rates for acute respiratory tract infections (ARTIs) at the high-volume rural UCCs before and after the implementation of three behavioral interventions: physician/patient education, public commitment, and peer comparison. The peer comparison intervention involved sending individual prescribing data and a blinded ranking email to providers.
The interventions were based on work from the MITIGATE study, which found that stewardship interventions tailored to the local site and setting reduced antibiotic prescribing for ARTIs by a third. An interrupted time series analysis (ITS) compared prescribing for ARTIs at the urgent care centers over a 16-month period before the intervention and 6 months during the intervention, a period that covered two flu seasons.
The analysis found a lower percentage of antibiotic-inappropriate prescribing during the intervention-period (58.5%) flu season (2018-19) than during the pre–intervention-period (73%) flu season (2017-18), resulting in an absolute 14.5% decrease in inappropriate prescribing for ARTIs, or about 981 prescriptions averted. The ITS analysis revealed that the estimated mean percent of antibiotic-inappropriate prescribing for ARTI decreased by 2.2% per month during the intervention period, compared with –0.71% during the pre-intervention period.
"The observed decrease in antibiotic-inappropriate prescribing for ARTI in this study suggests that utilizing a behavioral science approach may improve judicious use of antibiotics in community UCCs," the authors concluded.
Jun 6 Open Forum Infect Dis abstract
Higher US flu vaccine coverage linked to lower antibiotic prescribing
In another new study in Open Forum Infectious Diseases, researchers from the Center for Disease Dynamics, Economics & Policy in Washington, DC, and the University of Maryland School of Medicine in Baltimore found that increased influenza vaccination uptake was associated with state-level reductions in antibiotic use.
Using state-level monthly data on the number of dispensed antibiotic prescriptions from a large prescription drug database and seasonal flu vaccination coverage data from the Centers for Disease Control and Prevention's FluVaxView database, the researchers conducted a retrospective analysis of US flu vaccination coverage and antibiotic prescribing rates from 2010 through 2017. They used a fixed-effects regression analysis to analyze the relationship between vaccine coverage rates and the number of antibiotic prescriptions per 1,000 residents from January to March of each year. They also looked at the impact of vaccination on prescribing by age-group.
After controlling for access to healthcare, socioeconomic differences, vaccine effectiveness, climate, and state-level differences, the researchers found a significant negative association between increased influenza vaccination rates and antibiotic use rates.
A ten-percentage point increase in vaccine coverage was associated with 6.5% reduction in prescription rates, equivalent to 14.2 fewer antibiotic prescriptions per 1,000 individuals (95% confidence interval [CI], 6.0 to 22.4, P = 0.001). Increased vaccination coverage reduced prescribing rates in the pediatric population (0 to 18 years) by 6.0% or 15.2 prescriptions per 1,000 individuals (95% CI, 9.0 to 21.3; P < 0.001), and in those over 65 years by 5.2% or 12.8 prescriptions per 1,000 individuals (95% CI, 6.5 to 19.2, P < 0.001).
"Substantially boosting seasonal influenza vaccination coverage should be a central element of efforts to reduce use of antibiotics," the authors of the study wrote.
Jun 6 Open Forum Infect Dis abstract