Iowa City Veterans Affairs Health Care System, Iowa City, Iowa.
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Infect Control Hosp Epidemiol. 2021 Jun;42(6):694-701. doi: 10.1017/ice.2020.1289. Epub 2020 Dec 14.
Assessments of antibiotic prescribing in ambulatory care have largely focused on viral acute respiratory infections (ARIs). It is unclear whether antibiotic prescribing for bacterial ARIs should also be a target for antibiotic stewardship efforts. In this study, we evaluated antibiotic prescribing for viral and potentially bacterial ARIs in patients seen at emergency departments (EDs) and urgent care centers (UCCs).
This retrospective cohort included all ED and UCC visits by patients who were not hospitalized and were seen during weekday, daytime hours during 2016-2018 in the Veterans Health Administration (VHA). Guideline concordance was evaluated for viral ARIs and for 3 potentially bacterial ARIs: acute exacerbation of COPD, pneumonia, and sinusitis.
There were 3,182,926 patient visits across 129 sites: 80.7% in EDs and 19.3% in UCCs. Mean patient age was 60.2 years, 89.4% were male, and 65.6% were white. Antibiotics were prescribed during 608,289 (19.1%) visits, including 42.7% with an inappropriate indication. For potentially bacterial ARIs, guideline-concordant management varied across clinicians (median, 36.2%; IQR, 26.0-52.7) and sites (median, 38.2%; IQR, 31.7-49.4). For viral ARIs, guideline-concordant management also varied across clinicians (median, 46.2%; IQR, 24.1-68.6) and sites (median, 40.0%; IQR, 30.4-59.3). At the clinician and site levels, we detected weak correlations between guideline-concordant management for viral ARIs and potentially bacterial ARIs: clinicians (r = 0.35; P = .0001) and sites (r = 0.44; P < .0001).
Our findings suggest that, across EDs and UCCs within VHA, there are major opportunities to improve management of both viral and potentially bacterial ARIs. Some clinicians and sites are more frequently adhering to ARI guideline recommendations on antibiotic use.
在门诊环境中，对抗生素处方的评估主要集中在病毒性急性呼吸道感染（ARI）上。目前尚不清楚细菌性 ARI 的抗生素处方是否也应成为抗生素管理工作的目标。在这项研究中，我们评估了在退伍军人健康管理局（VHA）的急诊部（ED）和紧急护理中心（UCC）就诊的患者中病毒性和潜在细菌性 ARI 的抗生素处方。
这项回顾性队列研究纳入了在 2016 年至 2018 年期间工作日白天时段在 129 个地点就诊且未住院的所有 ED 和 UCC 患者就诊。评估了病毒性 ARI 以及 3 种潜在细菌性 ARI（COPD 急性加重、肺炎和鼻窦炎）的指南一致性。
共有 3182926 名患者就诊，涉及 129 个地点：80.7%在 ED，19.3%在 UCC。患者平均年龄为 60.2 岁，89.4%为男性，65.6%为白人。在 608289 次就诊中（19.1%）开具了抗生素，其中 42.7%的处方指征不恰当。对于潜在细菌性 ARI，临床医生之间的管理一致性存在差异（中位数，36.2%；IQR，26.0-52.7）和地点之间（中位数，38.2%；IQR，31.7-49.4）。对于病毒性 ARI，临床医生之间的管理一致性也存在差异（中位数，46.2%；IQR，24.1-68.6）和地点之间（中位数，40.0%；IQR，30.4-59.3）。在临床医生和地点层面，我们检测到病毒性 ARI 和潜在细菌性 ARI 的管理一致性之间存在弱相关性：临床医生（r=0.35；P=0.0001）和地点（r=0.44；P<.0001）。
我们的研究结果表明，在 VHA 的 ED 和 UCC 中，在病毒性和潜在细菌性 ARI 的管理方面有很大的改进空间。一些临床医生和地点更频繁地遵守 ARI 抗生素使用指南建议。
