1Iowa City Veterans Affairs Health Care System,Iowa City,Iowa.
3College of Pharmacy,University of Iowa,Iowa City,Iowa.
Infect Control Hosp Epidemiol. 2018 Jan;39(1):64-70. doi: 10.1017/ice.2017.250. Epub 2017 Dec 28.
OBJECTIVE The optimal approach to auditing outpatient antimicrobial prescribing has not been established. We assessed how different types of electronic data-including prescriptions, patient-visits, and International Classification of Disease, Tenth Revision (ICD-10) codes-could inform automated antimicrobial audits. DESIGN Outpatient visits during 2016 were retrospectively reviewed, including chart abstraction, if an antimicrobial was prescribed (cohort 1) or if the visit was associated with an infection-related ICD-10 code (cohort 2). Findings from cohorts 1 and 2 were compared. SETTING Primary care clinics and the emergency department (ED) at the Iowa City Veterans Affairs Medical Center. RESULTS In cohort 1, we reviewed 2,353 antimicrobial prescriptions across 52 providers. ICD-10 codes had limited sensitivity and positive predictive value (PPV) for validated cases of cystitis and pneumonia (sensitivity, 65.8%, 56.3%, respectively; PPV, 74.4%, 52.5%, respectively). The volume-adjusted antimicrobial prescribing rate was 13.6 per 100 ED visits and 7.5 per 100 primary care visits. In cohort 2, antimicrobials were not indicated in 474 of 851 visits (55.7%). The antimicrobial overtreatment rate was 48.8% for the ED and 59.7% for primary care. At the level of the individual prescriber, there was a positive correlation between a provider's volume-adjusted antimicrobial prescribing rate and the individualized rates of overtreatment in both the ED (r=0.72; P<.01) and the primary care setting (r=0.82; P=0.03). CONCLUSIONS In this single-center study, ICD-10 codes had limited sensitivity and PPV for 2 infections that typically require antimicrobials. Electronically extracted data on a provider's rate of volume-adjusted antimicrobial prescribing correlated with the frequency at which unnecessary antimicrobials were prescribed, but this may have been driven by outlier prescribers. Infect Control Hosp Epidemiol 2018;39:64-70.
目前尚未确定审核门诊抗菌药物处方的最佳方法。我们评估了不同类型的电子数据（包括处方、就诊记录和国际疾病分类，第 10 版（ICD-10）代码）如何为自动抗菌药物审核提供信息。
回顾性分析了 2016 年的门诊就诊记录，包括如果开具了抗菌药物（队列 1）或就诊与感染相关的 ICD-10 代码相关（队列 2）的情况。比较了队列 1 和队列 2 的结果。
爱荷华市退伍军人事务医疗中心的基层医疗诊所和急诊部。
在队列 1 中，我们审查了 52 名医生开具的 2353 份抗菌药物处方。ICD-10 代码对验证的膀胱炎和肺炎病例的敏感性和阳性预测值（PPV）有限（敏感性分别为 65.8%和 56.3%；PPV 分别为 74.4%和 52.5%）。调整抗菌药物使用量后的就诊率为每 100 次急诊就诊 13.6 次，每 100 次基层医疗就诊 7.5 次。在队列 2 中，851 次就诊中有 474 次（55.7%）不需要抗菌药物。急诊和基层医疗中抗菌药物过度治疗的比例分别为 48.8%和 59.7%。在个体医生层面，医生的调整抗菌药物使用量就诊率与急诊（r=0.72；P<.01）和基层医疗（r=0.82；P=0.03）中过度治疗的个体化率呈正相关。
在这项单中心研究中，ICD-10 代码对两种通常需要抗菌药物治疗的感染的敏感性和 PPV 有限。关于医生调整抗菌药物使用量就诊率的电子提取数据与不必要抗菌药物处方的频率相关，但这可能是由离群值医生驱动的。感染控制与医院流行病学 2018；39：64-70.
