Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2019/06/stewardship-resistance-scan-jun-28-2019
Stewardship / Resistance Scan for Jun 28, 2019
Dental overprescribing in Japan; Rapid tests and unneeded antibiotics
Filed Under:
Antimicrobial Stewardship; Diagnostics
[h=3]Dentist survey finds antimicrobial overprescribing may be common[/h] A survey of Japanese dentists indicates that attitudes toward antimicrobial prophylaxis vary widely, with many reporting going against current guidelines, Japanese researchers reported today in a letter in Infection Control and Hospital Epidemiology.
The online questionnaire was sent to 231 dentists attending a regional dental conference, and 111 responded. Regarding the use of prophylactic antimicrobials against infective endocarditis, more than 80% of respondents said they understood the guidelines for prevention, yet more than 70% said they believe it's important to continue administering antimicrobials after a dental procedure, and more than 80% reported having prescribed prophylactic antimicrobials to patients with high-risk cardiac conditions both before and after a procedure, even though that contradicts the current guidelines.
In addition, the questionnaire results showed that antimicrobial prophylaxis for patients with non-high-risk cardiac condition was also common, even though that too goes against current guidelines. And more than half of the respondents reported prescribing antimicrobials only after an invasive dental procedure to prevent local infection and complications, even though guidelines recommend administering antimicrobial prophylaxis before a procedure.
The authors of the letter say the self-reported behavior reflects deeply entrenched misperceptions about the relevant pathophysiology and fears of litigation.
"Current practice patterns suggest that antimicrobials may be overprescribed in dentistry," they write. "Intervention is urgently needed to optimize antimicrobial prescription in dentistry."
Jun 28 Infect Control Hosp Epidemiol abstract
[h=3]Study indicates potential need for stewardship of rapid diagnostics[/h] In another study today in Infection Control and Hospital Epidemiology, researchers found that despite diagnosis of a viral respiratory infection with a rapid diagnostic test, more than 20% of patients discharged from three emergency departments (EDs) in a California health system were prescribed antibiotics.
The retrospective study found that, of 323 patients discharged from the emergency departments from October 2016 to March 2017 with a viral respiratory infection?diagnosed by a multiplex polymerase chain reaction (PCR) test?68 (21.1%) were prescribed antibiotics. Multivariate analysis identified several factors associated with patients who received antibiotics, including age (median, 59.3 vs 43 years; P = .04), longer duration of symptoms (median 4 vs 2 days; P = .002), receipt of antibiotics in the preceding 7 days (27.9% vs 9.8%; P < .001), and abnormal chest x-rays (64.5% vs 28.4%; P < .001). The authors say these factors suggest increased clinical concern for a secondary bacterial infection or medical fragility.
Patients were more likely to receive antibiotics for a diagnosis of pneumonia (39.7% vs 1.6%; P < .001) or otitis media (7.4% vs 0.4%; P = .002), and were less likely with a diagnosis of upper respiratory infection (2.9% vs 13.7%; P = .02) or influenza (20.6% vs 44.3%; P < .001).
The authors say the findings indicate the need for healthcare systems to implement more stringent stewardship of molecular diagnostics. They conclude, "Opportunities exist for antimicrobial stewardship strategies to incorporate rapid diagnostics in promoting judicious antibiotic usage in the ED."
Jun 28 Infect Control Hosp Epidemiol abstract
Stewardship / Resistance Scan for Jun 28, 2019
Dental overprescribing in Japan; Rapid tests and unneeded antibiotics
Filed Under:
Antimicrobial Stewardship; Diagnostics
[h=3]Dentist survey finds antimicrobial overprescribing may be common[/h] A survey of Japanese dentists indicates that attitudes toward antimicrobial prophylaxis vary widely, with many reporting going against current guidelines, Japanese researchers reported today in a letter in Infection Control and Hospital Epidemiology.
The online questionnaire was sent to 231 dentists attending a regional dental conference, and 111 responded. Regarding the use of prophylactic antimicrobials against infective endocarditis, more than 80% of respondents said they understood the guidelines for prevention, yet more than 70% said they believe it's important to continue administering antimicrobials after a dental procedure, and more than 80% reported having prescribed prophylactic antimicrobials to patients with high-risk cardiac conditions both before and after a procedure, even though that contradicts the current guidelines.
In addition, the questionnaire results showed that antimicrobial prophylaxis for patients with non-high-risk cardiac condition was also common, even though that too goes against current guidelines. And more than half of the respondents reported prescribing antimicrobials only after an invasive dental procedure to prevent local infection and complications, even though guidelines recommend administering antimicrobial prophylaxis before a procedure.
The authors of the letter say the self-reported behavior reflects deeply entrenched misperceptions about the relevant pathophysiology and fears of litigation.
"Current practice patterns suggest that antimicrobials may be overprescribed in dentistry," they write. "Intervention is urgently needed to optimize antimicrobial prescription in dentistry."
Jun 28 Infect Control Hosp Epidemiol abstract
[h=3]Study indicates potential need for stewardship of rapid diagnostics[/h] In another study today in Infection Control and Hospital Epidemiology, researchers found that despite diagnosis of a viral respiratory infection with a rapid diagnostic test, more than 20% of patients discharged from three emergency departments (EDs) in a California health system were prescribed antibiotics.
The retrospective study found that, of 323 patients discharged from the emergency departments from October 2016 to March 2017 with a viral respiratory infection?diagnosed by a multiplex polymerase chain reaction (PCR) test?68 (21.1%) were prescribed antibiotics. Multivariate analysis identified several factors associated with patients who received antibiotics, including age (median, 59.3 vs 43 years; P = .04), longer duration of symptoms (median 4 vs 2 days; P = .002), receipt of antibiotics in the preceding 7 days (27.9% vs 9.8%; P < .001), and abnormal chest x-rays (64.5% vs 28.4%; P < .001). The authors say these factors suggest increased clinical concern for a secondary bacterial infection or medical fragility.
Patients were more likely to receive antibiotics for a diagnosis of pneumonia (39.7% vs 1.6%; P < .001) or otitis media (7.4% vs 0.4%; P = .002), and were less likely with a diagnosis of upper respiratory infection (2.9% vs 13.7%; P = .02) or influenza (20.6% vs 44.3%; P < .001).
The authors say the findings indicate the need for healthcare systems to implement more stringent stewardship of molecular diagnostics. They conclude, "Opportunities exist for antimicrobial stewardship strategies to incorporate rapid diagnostics in promoting judicious antibiotic usage in the ED."
Jun 28 Infect Control Hosp Epidemiol abstract