Saleh Ezzeldin A, Schroeder Darrell R, Hanson Andrew C, Banerjee Ritu
Department of Pediatrics, Division of Pediatric Infectious Diseases, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Clin Res Infect Dis. 2015 Jan 10;2(1).
Antibiotics are commonly prescribed in pediatric outpatient settings; however, efforts to decrease inappropriate use have largely focused on inpatients. We obtained baseline metrics to identify conditions that may benefit from establishment of outpatient antimicrobial stewardship interventions (ASP). We evaluated rates and appropriateness of antibiotic prescribing for children with acute otitis media (AOM), community acquired pneumonia (CAP), and skin and soft tissue infections (SSTI) in ambulatory settings within a large healthcare system in the US Midwest. We retrospectively reviewed 77,821 visits and associated diagnostic codes for children less than 17 years seen in ambulatory settings within our health system from August 1, 2009 to July 31, 2010. We measured rates of antibiotic prescribing by location, provider type, patient age, and diagnosis, and assessed concordance with treatment guidelines for AOM, CAP, and SSTI. AOM, CAP, and SSTI comprised about 1/3 of all infections in the study population. Antibiotics were prescribed in 14,543 (18.7%) visits. Antibiotic prescribing rates were 1.1 to 1.2 times higher among Emergency Room (ER) providers compared to Pediatricians and Family Physicians. Antibiotics prescribed for AOM and SSTI were concordant with guidelines in approximately 97% of cases. In contrast, 47% of antibiotics prescribed for treatment of CAP in children < 5 years old were macrolides, which are not recommended first line therapy for CAP in this age group. Antibiotic prescribing for pediatric outpatients within our health system is not guideline-concordant for treatment of CAP.
抗生素在儿科门诊环境中通常会被开具；然而，减少不当使用的努力主要集中在住院患者身上。我们获取了基线指标，以确定可能受益于建立门诊抗菌药物管理干预措施（ASP）的情况。我们评估了美国中西部一个大型医疗系统中门诊环境下患有急性中耳炎（AOM）、社区获得性肺炎（CAP）以及皮肤和软组织感染（SSTI）的儿童的抗生素处方率及合理性。我们回顾性分析了2009年8月1日至2010年7月31日期间在我们医疗系统门诊就诊的17岁以下儿童的77,821次就诊及相关诊断代码。我们按地点、医疗服务提供者类型、患者年龄和诊断来衡量抗生素处方率，并评估与AOM、CAP和SSTI治疗指南的一致性。AOM、CAP和SSTI约占研究人群中所有感染的三分之一。在14,543次（18.7%）就诊中开具了抗生素。与儿科医生和家庭医生相比，急诊室（ER）医疗服务提供者的抗生素处方率高出1.1至1.2倍。为AOM和SSTI开具的抗生素在约97%的病例中符合指南。相比之下，5岁以下儿童CAP治疗中开具的抗生素有47%是大环内酯类药物，而该年龄组CAP的一线治疗不推荐使用此类药物。我们医疗系统内儿科门诊患者的抗生素处方在治疗CAP方面不符合指南。
