Serletti Lacey, Dutcher Lauren, Degnan Kathleen O, Szymczak Julia E, Cluzet Valerie, David Michael Z, Cressman Leigh, Glassman Lindsay W, Hamilton Keith W
Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Antimicrob Steward Healthc Epidemiol. 2023 Sep 5;3(1):e147. doi: 10.1017/ash.2023.418. eCollection 2023.
To determine antibiotic prescribing appropriateness for respiratory tract diagnoses (RTD) by season.
Retrospective cohort study.
Primary care practices in a university health system.
Patients who were seen at an office visit with diagnostic code for RTD.
Office visits for the entire cohort were categorized based on ICD-10 codes by the likelihood that an antibiotic was indicated (tier 1: always indicated; tier 2: sometimes indicated; tier 3: rarely indicated). Medical records were reviewed for 1,200 randomly selected office visits to determine appropriateness. Based on this reference standard, metrics and prescriber characteristics associated with inappropriate antibiotic prescribing were determined. Characteristics of antibiotic prescribing were compared between winter and summer months.
A significantly greater proportion of RTD visits had an antibiotic prescribed in winter [20,558/51,090 (40.2%)] compared to summer months [11,728/38,537 (30.4%)][standardized difference (SD) = 0.21]. A significantly greater proportion of winter compared to summer visits was associated with tier 2 RTDs (29.4% vs 23.4%, SD = 0.14), but less tier 3 RTDs (68.4% vs 74.4%, SD = 0.13). A greater proportion of visits in winter compared to summer months had an antibiotic prescribed for tier 2 RTDs (80.2% vs 74.2%, SD = 0.14) and tier 3 RTDs (22.9% vs 16.2%, SD = 0.17). The proportion of inappropriate antibiotic prescribing was higher in winter compared to summer months (72.4% vs 62.0%, < .01).
Increases in antibiotic prescribing for RTD visits from summer to winter were likely driven by shifts in diagnoses as well as increases in prescribing for certain diagnoses. At least some of this increased prescribing was inappropriate.
按季节确定呼吸道疾病诊断（RTD）的抗生素处方合理性。
回顾性队列研究。
大学健康系统中的基层医疗诊所。
因RTD诊断代码前来就诊的患者。
根据ICD - 10编码，将整个队列的就诊情况按使用抗生素的可能性进行分类（第1层：总是需要使用；第2层：有时需要使用；第3层：很少需要使用）。对随机抽取的1200次就诊的病历进行审查以确定合理性。基于此参考标准，确定与不适当抗生素处方相关的指标和开处方者特征。比较冬季和夏季的抗生素处方特征。
与夏季相比，冬季RTD就诊中开具抗生素的比例显著更高[20,558/51,090（40.2%）]，夏季为[11,728/38,537（(30.4%）][标准化差异（SD）= 0.21]。与夏季就诊相比，冬季就诊中与第2层RTD相关的比例显著更高（29.4%对23.4%，SD = 0.14），但第3层RTD的比例更低（68.4%对74.4%，SD = 0.13）。与夏季相比，冬季就诊中为第2层RTD开具抗生素的比例更高（80.2%对74.2%，SD = 0.14），为第3层RTD开具抗生素的比例也更高（22.9%对16.2%，SD = 0.17）。与夏季相比，冬季不适当抗生素处方的比例更高（72.4%对62.0%，P <.01）。
从夏季到冬季，RTD就诊的抗生素处方增加可能是由于诊断变化以及某些诊断的处方增加所致。这种增加的处方中至少有一些是不适当的。
