Becker's Clinical Quality & Infection Control

36 ANTIBIOTIC RESISTANCE & STEWARDSHIP Urgent care centers may be overprescribing antibiotics By Megan Knowles P atients with respiratory illnesses and colds may be more likely to get antibiotics when they visit an urgent care clinic — an unnecessary prescribing practice that could increase patients' risk of antibiotic-resistant infections, a study published in JAMA Internal Medicine found. "Taking an antibiotic when it is not needed provides no benefit and could be harmful," senior study author Katherine Fleming-Dutra, MD, deputy director of the CDC's Office of Antibiotic Stewardship, told Reuters. Unnecessary antibiotic use can increase patients' risk of antibiotic-re- sistant infections, among other health risks, Dr. Fleming-Dutra added. Here are six things to know about the study: 1. The researchers examined data on outpa- tient visits for Americans under 65 in 2014, including about 2.7 million urgent care visits, 58,000 retail clinic visits, 4.8 million emer- gency room visits and 148.5 million physician office visits. 2. e study found 39 percent of visits to urgent care centers resulted in antibiotic prescriptions. Moreover, 46 percent of patients who went to urgent care for conditions that antibiotics can't remedy still received antibiotic prescriptions. 3. Only 7.1 percent of physician office visits resulted in antibiotic prescriptions. Out of 9.2 million visits for colds, flu and other respiratory illnesses that do not require antibiotics, these were prescribed 17 percent of the time. 4. Fourteen percent of ER visits involved antibi- otic prescriptions, as did 25 percent of visits for conditions that did not need antibiotics. 5. About 36 percent of visits at retail clinics were linked to antibiotic prescribing, as were 14 percent of visits for conditions that did not require antibiotics. 6. A limitation of the study was the reliance on insurance claims data designed for billing, which may not accurately show why patients received specific treatments, the study authors said. n UK researchers launch free database of 'forgotten' antibiotics By Anuja Vaidya A team of researchers based in the United Kingdom created a free, searchable database that can be used to find previously discon- tinued antibiotic agents, or 'forgotten' antibiotics. The database is called AntibioticDB. The team created the tool to spur drug discovery. The researchers view discontinued agents as an untapped resource for antibiotics and believe they can be used to circumvent the spread of antibiotic resistance. The database includes data on discovery, research, clinical trials and compounds awaiting approval. It also includes discontinued compounds, some dating back to the 1960s. The tool also provides information on why the development was discontinued. The database was spearheaded by Laura Piddock, PhD, a professor of microbiology with the University of Birmingham, and scientists from the John Innes Centre in Norwich, England. "We wanted to establish the current status of the drug-discovery pipeline in antibiot- ic development — particularly to look at compounds that might have been dropped in the past to see if they could be resuscitated," said Tony Maxwell, PhD, a study author and project leader in biological chemistry with the John Innes Centre. n Penicillin allergy indicates higher risk of developing MRSA, C. diff By Anuja Vaidya A study published in The BMJ examined the link between a penicil- lin allergy and the development of methicillin-resistant Staphylo- coccus aureus and Clostridium difficile. Researchers conducted a population-based matched cohort study in a United Kingdom-based general practice from 1995 to 2015. They exam- ined 301,399 adults without previous MRSA or C. diff diagnoses enrolled in the Health Improvement Network database, of which 64,141 had a penicillin allergy and 237,258 comparators matched on age, sex and study entry time. The study shows that during a mean follow-up of six years, the adults with penicillin allergy and matched comparators, 1,365 developed MRSA and 1,688 developed C. diff. Among patients with penicillin allergy, the adjusted hazard ratio was 1.69 for MRSA and 1.26 for C. diff. Additionally, the adjusted incidence rate ratios for antibiotic use among patients with penicil- lin allergies were 4.15 for macrolides, 3.89 for clindamycin and 2.10 for fluoroquinolones. "Systematically addressing penicillin allergies may be an important public health strategy to reduce the incidence of MRSA and C. diff among pa- tients with a penicillin allergy label," the study authors concluded. n

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