University of North Dakota School of Medicine, Grand Forks, ND, USA.
University of North Dakota School of Medicine, Department of Internal Medicine, Grand Forks, ND, USA.
Am J Emerg Med. 2021 Sep;47:66-69. doi: 10.1016/j.ajem.2021.03.018. Epub 2021 Mar 10.
Antibiotic stewardship programs have been a major focus in recent years to curtail antibiotic resistance. The purpose of this study was to evaluate antibiotic utilization for acute respiratory tract infections (ARTI) in the Emergency Department (ED) setting.
A retrospective analysis of adult ARTI visits to EDs utilizing 2011-2017 National Hospital Ambulatory Medical Care Survey- Emergency Department (NHAMCS-ED) datasets was conducted. Included were all visits of adults (≥18 years) diagnosed with ARTI. Antibiotics were determined based upon NHAMCS-ED use of the Multum Lexicon Drug Database coding system. All significance tests were two-sided, P-value <0.05 for significance.
A total of 4632 unweighted ED visits, which represented more than 28 million US ED visits from 2011 to 2017, with 57.2% receiving a prescription for antibiotics. Antibiotic prescriptions for ARTI significantly declined from 65.8% in 2011 to 54.3% in 2017 (P = 0.046). Among all visits, patients were more likely to receive an antibiotic if they were over age 45 (33.0% vs 27.6%, P = 0.005), male (36.7% vs. 32.3%, P = 0.039), and presenting in a non-MSA ED (21.4% vs. 14.5%, P = 0.002). No association was found between antibiotic prescription and race (P = 0.076) insurance (P = 0.488), CBC (P = 0.148), x-ray (P = 0.278), and blood cultures (P = 0.182).
We found a significant reduction in the utilization of antibiotics among adult ARTI visits to U.S. EDs from 2011 to 2017. This is an improvement from previous studies which showed no change, suggesting that antimicrobial stewardship efforts may be impacting overall antibiotic use and should continue to be practiced.
抗生素管理计划近年来一直是遏制抗生素耐药性的重点。本研究的目的是评估急诊科（ED）急性呼吸道感染（ARTI）的抗生素使用情况。
利用 2011-2017 年全国医院门诊医疗调查-急诊科（NHAMCS-ED）数据集对 ED 成人 ARTI 就诊进行回顾性分析。包括所有被诊断为 ARTI 的成年人就诊。抗生素是根据 NHAMCS-ED 使用 Multum Lexicon 药物数据库编码系统确定的。所有显著性检验均为双侧检验，P 值<0.05 为有显著性差异。
共有 4632 个未加权 ED 就诊，代表了 2011 年至 2017 年期间超过 2800 万例美国 ED 就诊，其中 57.2%的就诊者开具了抗生素处方。2011 年至 2017 年，ARTI 的抗生素处方比例从 65.8%显著下降至 54.3%（P = 0.046）。在所有就诊者中，如果患者年龄大于 45 岁（33.0%比 27.6%，P = 0.005）、男性（36.7%比 32.3%，P = 0.039）或在非大都市统计区（MSA）ED 就诊（21.4%比 14.5%，P = 0.002），他们更有可能接受抗生素治疗。抗生素处方与种族（P = 0.076）、保险（P = 0.488）、全血细胞计数（CBC）（P = 0.148）、X 光（P = 0.278）和血培养（P = 0.182）无关。
我们发现，2011 年至 2017 年期间，美国 ED 成人 ARTI 就诊抗生素使用率显著下降。这是对之前研究的改进，之前的研究显示抗生素使用没有变化，这表明抗菌药物管理工作可能正在影响整体抗生素使用，应继续实践。
