Evans David, Fortin-Leung Kingsley, Kumar Vishnu Ravi, Ma Yanru, Asrani Radhika Prakash, Wiley Zanthia, Fridkin Scott K
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Antimicrob Steward Healthc Epidemiol. 2024 Dec 20;4(1):e221. doi: 10.1017/ash.2024.472. eCollection 2024.
Examine the relationship between patients' race and prescriber antibiotic choice while accounting for differences in underlying illness and infection severity.
Retrospective cohort analysis.
Acute care facilities within an academic healthcare system.
Adult inpatients from January 2019 through June 2022 discharged from the Hospital Medicine Service with an ICD-10 Code for Pneumonia.
We describe variability in days of therapy of antimicrobials with activity against (anti- agents) or against MRSA (anti-MRSA agents), by patient's race and ethnicity. We estimated the likelihood of receipt of any anti- agents by race and modeled the effect of race on rate of use, adjusting for age, severity, and indication.
5,820 patients with 6,700 encounters were included. After adjusting for broad indication, severity, underlying illness, and age, use of anti- agents were less likely among non-Hispanic Black patients than other race groups, although this effect was limited to younger patients (adjusted odds ratio [aOR] 0.45, 95% confidence interval [CI] 0.29, 0.70), and not older ones (aOR 0.98; 95% CI 0.85, 1.13); use of anti-MRSA agents were similar between groups. Among patients receiving any anti- agents, Black patients received them for relatively lower proportion of their inpatient stay (incidence rate ratio 0.91; 95% CI 0.87, 0.96).
We found difference in use of anti- agents between non-Hispanic Black patients and other patients that could not be easily explained by indications or underlying illness, suggesting unmeasured factors may be playing a role in treatment decisions.
在考虑潜在疾病和感染严重程度差异的情况下，研究患者种族与开处方者抗生素选择之间的关系。
回顾性队列分析。
学术医疗系统内的急性护理机构。
2019年1月至2022年6月从医院内科出院且患有肺炎ICD-10编码的成年住院患者。
我们按患者种族和民族描述了对（抗剂）或对耐甲氧西林金黄色葡萄球菌（抗MRSA剂）有活性的抗菌药物治疗天数的变异性。我们估计了按种族接受任何抗剂的可能性，并对种族对使用率的影响进行建模，同时调整年龄、严重程度和适应症。
纳入了5820例患者的6700次就诊。在调整广泛适应症、严重程度、潜在疾病和年龄后，非西班牙裔黑人患者使用抗剂的可能性低于其他种族组，尽管这种影响仅限于年轻患者（调整后的优势比[aOR]为0.45，95%置信区间[CI]为0.29，0.70），而老年患者则不然（aOR为0.98；95%CI为0.85，1.13）；各组之间抗MRSA剂的使用相似。在接受任何抗剂的患者中，黑人患者在住院期间接受抗剂的比例相对较低（发病率比为0.91；95%CI为0.87，0.96）。
我们发现非西班牙裔黑人患者与其他患者在抗剂使用上存在差异，这种差异难以用适应症或潜在疾病来解释，这表明未测量的因素可能在治疗决策中起作用。
