Department of Veterans Affairs (VA), Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital (151H), Hines, IL, USA.
PM R. 2010 Feb;2(2):101-9. doi: 10.1016/j.pmrj.2009.11.002. Epub 2010 Feb 1.
To assess the association between antibiotic prescribing for acute respiratory infection (ARI) and subsequent health-care utilization in veterans with spinal cord injury and disorder (SCI/D).
Retrospective cohort of veterans with SCI/D.
Veterans Affairs medical facilities that provide outpatient care.
Veterans with SCI/D with a diagnosis of acute bronchitis or upper respiratory infection during an outpatient visit between fiscal year 2006 and 2007 that did not result in same-day hospitalization.
Receipt of a new antibiotic prescription occurring within 3 days before or after an ARI visit.
Subsequent outpatient visit or hospitalization within 30 days of the index ARI visit.
A total of 1277 patients were identified with ARI; 53.2% were prescribed an antibiotic. An outpatient clinic visit within 30 days of the index ARI visit occurred in 47.0% of patients. Receipt of an antibiotic prescription was not associated with a subsequent outpatient visit. However, in those with certain chronic respiratory conditions (cough, shortness of breath, bronchitis not specified as acute or chronic, and allergic rhinitis), those prescribed antibiotics were less likely to return for an outpatient visit than those not prescribed antibiotics (adjusted relative risk =0.77, 95% confidence interval = 0.61-0.97); no association was observed in those patients without these conditions. A total of 7.9% of patients were hospitalized within 30 days and did not differ by prescribing group. The 30-day mortality rate was 0.6%.
Certain chronic respiratory conditions in veterans with SCI/D may be risk factors for increased health-care utilization and potentially poor outcomes if a patient is not treated with antibiotics for ARI. However, in those without these conditions, those with ARI who were prescribed antibiotics have similar utilization to those not prescribed antibiotics. These data suggest that in the absence of chronic respiratory conditions, antibiotic use for ARI can be curbed in this population that is at high risk for respiratory complications.
评估脊髓损伤和疾病（SCI/D）退伍军人急性呼吸道感染（ARI）治疗后抗生素使用与后续医疗保健利用之间的关系。
脊髓损伤和疾病退伍军人的回顾性队列。
提供门诊护理的退伍军人事务医疗设施。
2006 年至 2007 年门诊期间患有急性支气管炎或上呼吸道感染但未当天住院的 SCI/D 退伍军人，有急性支气管炎或上呼吸道感染诊断。
ARI 就诊前 3 天内或后 3 天内开具新抗生素处方。
在索引 ARI 就诊后 30 天内的后续门诊就诊或住院。
共确定了 1277 名患有 ARI 的患者；其中 53.2%开了抗生素。47.0%的患者在索引 ARI 就诊后 30 天内进行了门诊就诊。抗生素处方的开具与后续门诊就诊无相关性。然而，在患有某些慢性呼吸系统疾病（咳嗽、呼吸急促、未明确为急性或慢性的支气管炎和过敏性鼻炎）的患者中，与未开抗生素的患者相比，开抗生素的患者不太可能再次就诊（调整后的相对风险=0.77，95%置信区间=0.61-0.97）；在没有这些疾病的患者中没有观察到这种相关性。30 天内共有 7.9%的患者住院，与开处方组无差异。30 天死亡率为 0.6%。
在患有 SCI/D 的退伍军人中，某些慢性呼吸系统疾病可能是导致医疗保健利用率增加和潜在不良结局的危险因素，如果不对 ARI 患者使用抗生素治疗。然而，在没有这些疾病的情况下，患有 ARI 且开具抗生素的患者与未开具抗生素的患者的使用情况相似。这些数据表明，在没有慢性呼吸系统疾病的情况下，在该人群中可以控制抗生素治疗 ARI 的使用，因为该人群存在高呼吸并发症风险。
