School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia.
School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
BMC Infect Dis. 2020 Apr 25;20(1):306. doi: 10.1186/s12879-020-05029-z.
It is commonly recommended that microbiological assessment should accompany the use of antibiotics prone to resistance. We sought to estimate the rate of microbiology testing and compare this to dispensing of the World Health Organization classified "watch" group antibiotics in primary care.
Data from a cohort of older adults (mean age 69 years) were linked to Australian national health insurance (Pharmaceutical Benefits Scheme & Medicare Benefits Schedule) records of community-based antibiotic dispensing and microbiology testing in 2015. Participant characteristics associated with greater watch group antibiotic dispensing and microbiology testing were estimated using adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) in multivariable zero-inflated negative binomial regression models.
In 2015, among 244,299 participants, there were 63,306 watch group antibiotic prescriptions dispensed and 149,182 microbiology tests conducted; the incidence rate was 0.26 per person-year for watch group antibiotic dispensing and 0.62 for microbiology testing. Of those antibiotic prescriptions, only 19% were accompanied by microbiology testing within - 14 to + 7 days. After adjusting for socio-demographic factors and co-morbidities, individuals with chronic respiratory diseases were more likely to receive watch group antibiotics than those without, e.g. asthma (aIRR:1.59, 95%CI:1.52-1.66) and chronic obstructive pulmonary disease (COPD) (aIRR:2.71, 95%CI:2.48-2.95). However, the rate of microbiology testing was not comparably higher among them (with asthma aIRR:1.03, 95%CI:1.00-1.05; with COPD aIRR:1.00, 95%CI:0.94-1.06).
Priority antibiotics with high resistance risk are commonly dispensed among community-dwelling older adults. The discord between the rate of microbiology testing and antibiotic dispensing in adults with chronic respiratory diseases suggests the potential for excessive empirical prescribing.
通常建议在使用易产生耐药性的抗生素时应进行微生物学评估。我们旨在评估微生物学检测率，并将其与初级保健中世界卫生组织分类的“观察”类抗生素的配药情况进行比较。
我们将 2015 年年龄在 69 岁左右的老年人队列数据与澳大利亚国家健康保险（药品福利计划和医疗保险福利计划）的社区抗生素配药和微生物学检测记录相关联。使用多变量零膨胀负二项回归模型中的调整发病率比（aIRR）和 95%置信区间（CI）来估计与观察类抗生素配药和微生物学检测量较大相关的参与者特征。
2015 年，在 244299 名参与者中，开出了 63306 张观察类抗生素处方，进行了 149182 次微生物学检测；观察类抗生素的发病率为人年 0.26 次，微生物学检测的发病率为人年 0.62 次。在这些抗生素处方中，只有 19%在-14 至+7 天内进行了微生物学检测。在调整了社会人口因素和合并症后，患有慢性呼吸系统疾病的个体比没有慢性呼吸系统疾病的个体更有可能接受观察类抗生素治疗，例如哮喘（aIRR：1.59，95%CI：1.52-1.66）和慢性阻塞性肺疾病（COPD）（aIRR：2.71，95%CI：2.48-2.95）。然而，他们进行微生物学检测的比例并没有相应提高（哮喘的 aIRR：1.03，95%CI：1.00-1.05；COPD 的 aIRR：1.00，95%CI：0.94-1.06）。
高耐药风险的优先抗生素在社区居住的老年人中经常开出。患有慢性呼吸系统疾病的成年人中微生物学检测率与抗生素配药率之间的差异表明，经验性处方可能过多。
