Keintz Mackenzie R, Abbas Anum, Lyden Elizabeth, Ma Jihyun, Bares Sara H, Van Schooneveld Trevor C, Marcelin Jasmine R
Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Open Forum Infect Dis. 2022 May 3;9(7):ofac218. doi: 10.1093/ofid/ofac218. eCollection 2022 Jul.
Antibiotic overuse increases health care cost and promotes antimicrobial resistance. People with HIV (PWH) who develop acute respiratory infections (ARIs) may be assumed to be "higher risk," compared with non-PWH, but comparative antibiotic use evaluations have not been performed.
This observational, single-center study compared antibiotic prescribing in independent clinical encounters for PWH and non-PWH diagnosed with ARI in outpatient clinical practices using International Classification of Diseases, 10th Revision, codes between January 1, 2014, and April 30, 2018. The Fisher exact test compared categorical variables with antibiotic prescribing patterns.
There were 209 patients in the PWH cohort vs 398 patients in the non-PWH cohort. PWH had a median CD4+ count of 610 cells/mm, with 91% on antiretroviral therapy and 78% virally suppressed. Thirty-seven percent of all visits resulted in an antibiotic prescription, and 89% were inappropriate. Antibiotics were prescribed more frequently in non-PWH (35% PWH vs 40% non-PWH; = .172) and managed according to guidelines more often in PWH (37% PWH vs 30% non-PWH; = .039). Antibiotics were prescribed appropriately most frequently in PWH managed by HIV clinicians (29% PWH managed by HIV clinician vs 12% PWH managed by non-HIV clinician vs 8% non-PWH; = .010). HIV clinicians prescribed antibiotics for a mean duration of 5.9 days vs PWH managed by a non-HIV clinician for 9.1 days vs non-PWH for 7.6 days ( < .0001).
Outpatient antibiotic overuse remains prevalent among patients evaluated for ARI. We found less frequent inappropriate antibiotic use in PWH. Prescriber specialty, rather than HIV diagnosis, was related to appropriateness of antimicrobial prescribing.
抗生素的过度使用增加了医疗成本并促进了抗菌药物耐药性。与未感染艾滋病毒的人相比，感染艾滋病毒（PWH）且发生急性呼吸道感染（ARI）的人可能被认为“风险更高”，但尚未进行抗生素使用情况的比较评估。
这项观察性单中心研究比较了2014年1月1日至2018年4月30日期间，在门诊临床实践中使用国际疾病分类第10版编码诊断为ARI的PWH和未感染艾滋病毒的人在独立临床诊疗中的抗生素处方情况。Fisher精确检验比较了抗生素处方模式的分类变量。
PWH队列中有209名患者，未感染艾滋病毒的队列中有398名患者。PWH的CD4 +细胞计数中位数为610个/mm，91%接受抗逆转录病毒治疗，78%病毒得到抑制。所有就诊中有37%开出了抗生素处方，其中89%不恰当。未感染艾滋病毒的人更频繁地开具抗生素（35%的PWH vs 40%的未感染艾滋病毒的人；P = 0.172），而PWH更常按照指南进行处理（37%的PWH vs 30%的未感染艾滋病毒的人；P = 0.039）。由艾滋病毒临床医生管理的PWH中抗生素处方适当的频率最高（由艾滋病毒临床医生管理的PWH为29%，由非艾滋病毒临床医生管理的PWH为12%，未感染艾滋病毒的人为8%；P = 0.010）。艾滋病毒临床医生开具抗生素的平均疗程为5.9天，由非艾滋病毒临床医生管理的PWH为9.1天，未感染艾滋病毒的人为7.6天（P < 0.0001）。
在接受ARI评估的患者中，门诊抗生素过度使用仍然普遍。我们发现PWH中不恰当抗生素使用的频率较低。处方医生的专业，而非艾滋病毒诊断，与抗菌药物处方的恰当性有关。
