Becker's Clinical Quality & Infection Control

23 ANTIBIOTIC RESISTANCE & STEWARDSHIP Nearly half of outpatient antibiotics prescribed without infection diagnosis By Megan Knowles O ne in five antibiotic prescriptions are provided without an in-person visit, and about half of outpatient antibiotics are prescribed without an infection-related diagnosis, according to a study presented at IDWeek 2018, an annual meeting for infectious diseases professionals. "We found that nearly half the time, clinicians have either a bad reason for prescribing antibiotics, or don't provide a reason at all," said lead study author Jeffrey Linder, MD. "When you consider about 80 percent of antibiotics are prescribed on an outpatient basis, that's a concern." The researchers examined about 500,000 antibiotic prescriptions pro- vided to more than 200,000 patients from November 2015 to October 2017. Prescribers included physicians, attending physicians, nurse practitioners and physician assistants. Here are three study insights: 1. Forty-six percent of antibiotic prescriptions lacked an infection-re- lated diagnosis, 29 percent noted something other than an infection diagnosis (such as high blood pressure or annual visit), and 17 per- cent were written with no diagnosis, the study found. 2. The findings stem in part from unclear diagnosis coding, but much of it reflects antibiotic prescribing for unnecessary reasons, such as prescriptions for infections caused by viruses, Dr. Linder said. 3. Of the 20 percent of antibiotics prescribed outside of an in-person visit, most were by phone (10 percent). Other prescriptions were through EHR systems. n Alternative antibiotics after C-sections may cause more infections By Megan Knowles U sing prophylactic antibiotics in cesarean-section delivery other than the recommended antibiotics, including cefazolin, was associated with a higher risk of surgical site infections, a study published in Obstetrics & Gynecology found. The researchers analyzed over 6,500 C-section deliveries that occurred from 2012-17. Although the use of recommended alternative antibiotics was not linked to an increased risk over cefazoline of a composite of several infections, including cellulitis, deep wound infection and sepsis — alternative antibiotic use was revealed to be linked to increased odds of contracting cellulitis. "Both standard alternative and inappropriate alternatives were asso- ciated with increased odds of surgical site infections compared with cefazolin," the researchers wrote. n Clinical checklist can cut antibiotic duration for staph infections, researchers find By Megan Knowles P hysicians shortened antibiotic duration for patients with uncomplicated staphylococ- cal bloodstream infections by about two days using a clinical checklist to identify eligible patients, a study published in JAMA found. e study, conducted by researchers at Durham, N.C.-based Duke Health, tested an algorithm that defines how long patients with staph blood- stream infections should get IV antibiotics. e study included 509 patients with staph blood- stream infections at 16 medical centers in the U.S. and Spain. e algorithm stems from several clinical char- acteristics that help physicians determine the in- fection's severity, including how long the patient has had a fever and blood culture results. About half of the patients were randomly assigned to the algorithm-guided duration of antibiotics. Physicians determined the duration of the remaining patients' antibiotic treatment based on standard practice. Patients in both groups recovered at the same rate, with 82 percent of the algorithm patients and 81.5 percent of the standard care patients having positive outcomes. Complication rates were also statistically simi- lar, but the study found a significant difference in antibiotic duration among patients with simple and uncomplicated infections, or those in which infection had not spread to other parts of the body. For these patients, the algorithm treatment plan let physicians stop IV antibiotics about two days sooner than similar patients receiving standard care (4.4 days versus 6.2 days). "Any reductions in the use of antibiotics to treat these infections would be a significant benefit in our effort to fight antibiotic resistance, partic- ularly when these measures can be undertaken without harm to patients," said lead study author omas Holland, MD. n

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