Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2022/04/stewardship-resistance-scan-apr-11-2022
Stewardship / Resistance Scan for Apr 11, 2022
COVID-linked antibiotic use in Medicare patients; Fluoroquinolone stewardship
Filed Under:
Antimicrobial Stewardship
Study: Medicare outpatients frequently received antibiotics for COVID-19
A review of data on Medicare beneficiaries during the first year of the COVID-19 pandemic found that nearly a third of outpatient COVID-19 visits were linked to an antibiotic prescription, mainly for azithromycin, Centers for Disease Control and Prevention (CDC) researchers reported late last week in JAMA.
The analysis of Medicare carrier claims and data from the Medicare Part D prescription drug plan from April 2020 to April 2021 found that 29.6% of more than 1.1 million COVID-19 outpatient visits were associated with an antibiotic prescription. The rate of prescribing varied by month, with higher rates of prescribing occurring during a wave of COVID-19 cases in the winter of 2020-21 (range, 17.5% in May 2020 to 33.3% in October 2020). Prescribing was highest in the emergency department (33.9%), followed by telehealth (28.4%), urgent care (25.8%), and office visits (23.9%).
Azithromycin was the most frequently prescribed antibiotic (50.7% of cases), followed by doxycycline (13%), amoxicillin (9.4%), and levofloxacin (6.7%). Urgent care had the highest percentage of azithromycin prescriptions (60.1%), followed by telehealth (55.7%), office visits (55.1%), and ED (47.4%).
Differences were observed by age, sex, and location, with non-Hispanic White beneficiaries receiving antibiotics for COVID-19 more frequently (30.6%) than other racial and ethnic groups, including American Indian/Alaska Native (24.1%), Asian/Pacific Islander (26.5%), Black (23.2%), and Hispanic (28.8%) patients.
Despite some early studies that indicated azithromycin might benefit COVID-19 patients, subsequent randomized clinical trials demonstrated no benefit.
"These observations reinforce the importance of improving appropriate antibiotic prescribing in outpatient settings and avoiding unnecessary antibiotic use for viral infections such as COVID-19 in older adult populations," the CDC researchers wrote.
Apr 8 JAMA research letter
Stewardship linked to drop in fluoroquinolones for urinary tract infections
A multifaceted antimicrobial stewardship intervention at a community health system dramatically reduced fluoroquinolone prescribing for urinary tract infections (UTIs), researchers reported today in Infection Control & Hospital Epidemiology.
The intervention implemented at Lee Health, a large community health system in Florida, included development of an antimicrobial stewardship team to oversee the intervention, dissemination of a system-specific UTI treatment pathway with an emphasis on the use of non-fluoroquinolone antibiotics, and modification of the electronic health record to incorporate treatment recommendations. A fluoroquinolone stewardship dashboard was also created, and prescribers received monthly reports on the percentage of UTI visits for which fluoroquinolones were prescribed.
Originally implemented in four urgent care locations in April 2019, the intervention was extended to the system's 19 primary care clinics in August 2019.
Comparison of prescribing data from the 6-month post-intervention period (September 2019 to February 2020) with the pre-intervention period (September 2018 to February 2019) showed that the percentage of fluoroquinolone prescribing for UTIs fell from 17.6% pre-intervention to 3.0% post-intervention in the four urgent care clinics, and from 23.8% to 6.8% in the 19 primary care clinics. Percentages of any primary care clinic visits at which a fluoroquinolone was prescribed fell from 1.3% to 0.5%.
Sustained decreases in fluoroquinolone prescribing for UTIs were observed in a third assessment period compared with the pre-intervention period for both urgent (3%) and primary care (7%).
"Our initiative demonstrated that a multifaceted antimicrobial stewardship bundle had a significant and sustained impact on fluoroquinolone utilization in urgent care and primary care clinics," the study authors wrote. "Although the emphasis of our intervention was on UTI-related visits, the impact potentially extended beyond UTI visits, given the large decrease in total fluoroquinolone prescriptions, which was not completely accounted for by visits with UTI-related diagnosis codes."
Apr 11 Infect Control Hosp Epidemiol study
Stewardship / Resistance Scan for Apr 11, 2022
COVID-linked antibiotic use in Medicare patients; Fluoroquinolone stewardship
Filed Under:
Antimicrobial Stewardship
Study: Medicare outpatients frequently received antibiotics for COVID-19
A review of data on Medicare beneficiaries during the first year of the COVID-19 pandemic found that nearly a third of outpatient COVID-19 visits were linked to an antibiotic prescription, mainly for azithromycin, Centers for Disease Control and Prevention (CDC) researchers reported late last week in JAMA.
The analysis of Medicare carrier claims and data from the Medicare Part D prescription drug plan from April 2020 to April 2021 found that 29.6% of more than 1.1 million COVID-19 outpatient visits were associated with an antibiotic prescription. The rate of prescribing varied by month, with higher rates of prescribing occurring during a wave of COVID-19 cases in the winter of 2020-21 (range, 17.5% in May 2020 to 33.3% in October 2020). Prescribing was highest in the emergency department (33.9%), followed by telehealth (28.4%), urgent care (25.8%), and office visits (23.9%).
Azithromycin was the most frequently prescribed antibiotic (50.7% of cases), followed by doxycycline (13%), amoxicillin (9.4%), and levofloxacin (6.7%). Urgent care had the highest percentage of azithromycin prescriptions (60.1%), followed by telehealth (55.7%), office visits (55.1%), and ED (47.4%).
Differences were observed by age, sex, and location, with non-Hispanic White beneficiaries receiving antibiotics for COVID-19 more frequently (30.6%) than other racial and ethnic groups, including American Indian/Alaska Native (24.1%), Asian/Pacific Islander (26.5%), Black (23.2%), and Hispanic (28.8%) patients.
Despite some early studies that indicated azithromycin might benefit COVID-19 patients, subsequent randomized clinical trials demonstrated no benefit.
"These observations reinforce the importance of improving appropriate antibiotic prescribing in outpatient settings and avoiding unnecessary antibiotic use for viral infections such as COVID-19 in older adult populations," the CDC researchers wrote.
Apr 8 JAMA research letter
Stewardship linked to drop in fluoroquinolones for urinary tract infections
A multifaceted antimicrobial stewardship intervention at a community health system dramatically reduced fluoroquinolone prescribing for urinary tract infections (UTIs), researchers reported today in Infection Control & Hospital Epidemiology.
The intervention implemented at Lee Health, a large community health system in Florida, included development of an antimicrobial stewardship team to oversee the intervention, dissemination of a system-specific UTI treatment pathway with an emphasis on the use of non-fluoroquinolone antibiotics, and modification of the electronic health record to incorporate treatment recommendations. A fluoroquinolone stewardship dashboard was also created, and prescribers received monthly reports on the percentage of UTI visits for which fluoroquinolones were prescribed.
Originally implemented in four urgent care locations in April 2019, the intervention was extended to the system's 19 primary care clinics in August 2019.
Comparison of prescribing data from the 6-month post-intervention period (September 2019 to February 2020) with the pre-intervention period (September 2018 to February 2019) showed that the percentage of fluoroquinolone prescribing for UTIs fell from 17.6% pre-intervention to 3.0% post-intervention in the four urgent care clinics, and from 23.8% to 6.8% in the 19 primary care clinics. Percentages of any primary care clinic visits at which a fluoroquinolone was prescribed fell from 1.3% to 0.5%.
Sustained decreases in fluoroquinolone prescribing for UTIs were observed in a third assessment period compared with the pre-intervention period for both urgent (3%) and primary care (7%).
"Our initiative demonstrated that a multifaceted antimicrobial stewardship bundle had a significant and sustained impact on fluoroquinolone utilization in urgent care and primary care clinics," the study authors wrote. "Although the emphasis of our intervention was on UTI-related visits, the impact potentially extended beyond UTI visits, given the large decrease in total fluoroquinolone prescriptions, which was not completely accounted for by visits with UTI-related diagnosis codes."
Apr 11 Infect Control Hosp Epidemiol study
