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Senthinathan A, Penner M, Tu K, Morris AM, Craven BC, Li Z, Guan J, Jaglal SB. Identifying Patterns of Primary Care Antibiotic Prescribing for a Spinal Cord Injury (SCI) Cohort Using an Electronic Medical Records (EMR) Database. Top Spinal Cord Inj Rehabil 2023; 29:153-164. [PMID: 38174137 PMCID: PMC10759849 DOI: 10.46292/sci23-00047s] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Individuals with a spinal cord injury (SCI) are considered higher users of antibiotics. However, to date there have been no detailed studies investigating outpatient antibiotic use in this population. Objectives (1) To describe primary care antibiotic prescribing patterns in adults with SCI rostered to a primary care physician (PCP), and (2) to identify patient or PCP factors associated with number of antibiotics prescribed and antibiotic prescription duration. Methods A retrospective cohort study using linked health administrative and electronic medical records (EMR) databases from January 1, 2013 to December 31, 2015 among 432 adults with SCI in Ontario, Canada. Negative binomial regression analyses were conducted to identify patient or physician factors associated with number of antibiotics prescribed and prescription duration. Results During the study period, 61.1% of the SCI cohort received an antibiotic prescription from their PCP. There were 59.8% of prescriptions for urinary tract infections (UTI) and 24.6% of prescriptions for fluoroquinolones. Regression analysis found catheter use was associated with increased number of antibiotics prescribed (relative risk [RR] = 3.1; 95% CI, 2.3-4.1; p < .001) and late career PCPs, compared to early-career PCPs, prescribed a significantly longer duration (RR = 1.8; 95% CI, 1.1-3.1; p = .02). Conclusion UTIs were the number one prescription indication, and fluoroquinolones were the most prescribed antibiotic. Catheter use was associated with number of antibiotics, and PCP's years of practice was associated with duration. The study provided important information about primary care antibiotic prescribing in the SCI population and found that not all individuals received frequent antibiotics prescriptions.
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Affiliation(s)
- Arrani Senthinathan
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Melanie Penner
- Bloorview Research Institute / Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - Andrew M. Morris
- Antimicrobial Stewardship Program, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Infectious Diseases, Sinai Health, University Health Network, and University of Toronto, Toronto, ON, Canada
| | - B. Catharine Craven
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
| | | | | | - Susan B. Jaglal
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Rehabilitation Science Institute and Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Senthinathan A, Craven BC, Morris AM, Penner M, Tu K, Jaglal SB. Examining antibiotic prescribing and urine culture testing for urinary tract infections (UTIs) in a primary care spinal cord injury (SCI) cohort. Spinal Cord 2023; 61:345-351. [PMID: 37130883 DOI: 10.1038/s41393-023-00899-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVES To describe antibiotic prescribing and urine culture testing patterns for urinary tract infections (UTIs) in a primary care Spinal Cord Injury (SCI) cohort. SETTING A primary care electronic medical records (EMR) database in Ontario. METHODS Using linked EMR health administrative databases to identify urine culture and antibiotic prescriptions ordered in primary care for 432 individuals with SCI from January 1, 2013 to December 31, 2015. Descriptive statistics were conducted to describe the SCI cohort, and physicians. Regression analyses were conducted to determine patient and physician factors associated with conducting a urine culture and class of antibiotic prescription. RESULTS The average annual number of antibiotic prescriptions for UTI for the SCI cohort during study period was 1.9. Urine cultures were conducted for 58.1% of antibiotic prescriptions. Fluroquinolones and nitrofurantoin were the most frequently prescribed antibiotics. Male physicians and international medical graduates were more likely to prescribe fluroquinolones than nitrofurantoin for UTIs. Early-career physicians were more likely to order a urine culture when prescribing an antibiotic. No patient characteristics were associated with obtaining a urine culture or antibiotic class prescription. CONCLUSION Nearly 60% of antibiotic prescriptions for UTIs in the SCI population were associated with a urine culture. Only physician characteristics, not patient characteristics, were associated with whether or not a urine culture was conducted, and the class of antibiotic prescribed. Future research should aim to further understand physician factors with antibiotic prescribing and urine culture testing for UTIs in the SCI population.
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Affiliation(s)
- Arrani Senthinathan
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.
| | - B Catherine Craven
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Andrew M Morris
- Antimicrobial Stewardship Program, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Infectious Diseases, Sinai Health, University Health Network, and University of Toronto, Toronto, ON, Canada
| | - Melanie Penner
- Bloorview Research Institute / Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - Susan B Jaglal
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Science Institute and Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
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Ghimire K, Banjara MR, Marasini BP, Gyanwali P, Poudel S, Khatri E, Dhimal M. Antibiotics Prescription, Dispensing Practices and Antibiotic Resistance Pattern in Common Pathogens in Nepal: A Narrative Review. Microbiol Insights 2023; 16:11786361231167239. [PMID: 37066121 PMCID: PMC10102948 DOI: 10.1177/11786361231167239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 03/16/2023] [Indexed: 04/18/2023] Open
Abstract
Antimicrobial resistance (AMR) is increasing and it is a serious public health problem worldwide. Nepal is considered as one of the contributors for rising AMR due to the most prevalent irrational use of antibiotics. In this review, we have assessed the practices of antibiotic prescription and dispensing, and antibiotic resistance of commonly encountered bacteria in Nepal. There is exponential increase of therapeutic consumption of antibiotics either without clinician's prescription or irrational prescription. Almost half of the population in Nepal was found to purchase antibiotics easily from the nearby pharmacies without clinician's prescription. Irrational prescription is exceeded in remote areas which could be due to lack of access with health posts and hospitals. The third generation cephalosporins, which are considered as the last resort antibiotics were found to be relatively prescribed and dispensed higher as compared to other classes of antibiotics. Despite the existing limited functional surveillance system, antibiotic resistance among bacteria is increasing in Nepal because of irrational prescription, dispensing and consumption of antibiotics without prescription.
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Affiliation(s)
- Kalpana Ghimire
- Central Department of Microbiology,
Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology,
Tribhuvan University, Kirtipur, Kathmandu, Nepal
- Megha Raj Banjara, Central Department of
Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44618, Nepal.
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Kornfält Isberg H, Hedin K, Melander E, Mölstad S, Beckman A. Uncomplicated urinary tract infection in primary health care: presentation and clinical outcome. Infect Dis (Lond) 2020; 53:94-101. [PMID: 33073654 DOI: 10.1080/23744235.2020.1834138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Uncomplicated urinary tract infection (UTI) causes bothersome symptoms among women and is a leading cause for antibiotic prescribing in primary healthcare (PHC). METHODS A prospective observational study in eight different PHC centres in Sweden including 192 women with symptoms of uncomplicated UTI. Questionnaires and symptom diaries were used to retrieve patient data. All urine samples were analysed with urine culture and susceptibility testing. The aim was to describe the clinical presentation of symptoms in uncomplicated UTI in relation to bacterial findings in urine and to describe the course and duration of symptoms in relation to anamnestic factors, bacterial findings and antibiotic treatment. RESULTS Median symptom duration before seeking care was four days (IQR 1-7). Restrictions in daily life related to symptoms of uncomplicated UTI were reported by the majority (74%) of respondents. The median number of days concerning any symptom after consultation was 4.0 days (IQR 2.0-5.0) for patients treated with antibiotics, and 6.5 days (IQR 3.0-10.0) for patients not treated with antibiotics. There was an association between longer symptom duration after consultation and age over 50 years, relative risk (RR) 1.76 (95% CI 1.25-2.49). Antibiotic treatment RR 0.47 (95% CI 0.27-0.81) was associated with reported shorter duration of symptoms. CONCLUSIONS Women visiting primary health care with symptoms indicating uncomplicated UTI have symptoms for several days before seeking care and after consulting. A majority of patients feel restricted in their daily activities due to uncomplicated UTI. Older women and women not treated with antibiotics have the longest symptom duration after consultation.
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Affiliation(s)
| | - Katarina Hedin
- Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden.,Futurum, Jönköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Jönköping, Sweden
| | - Eva Melander
- Regional Center for Communicable Disease Control, Malmö, Sweden.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Sigvard Mölstad
- Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden
| | - Anders Beckman
- Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden
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Krieger MS, Denison CE, Anderson TL, Nowak MA, Hill AL. Population structure across scales facilitates coexistence and spatial heterogeneity of antibiotic-resistant infections. PLoS Comput Biol 2020; 16:e1008010. [PMID: 32628660 PMCID: PMC7365476 DOI: 10.1371/journal.pcbi.1008010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/16/2020] [Accepted: 06/02/2020] [Indexed: 12/31/2022] Open
Abstract
Antibiotic-resistant infections are a growing threat to human health, but basic features of the eco-evolutionary dynamics remain unexplained. Most prominently, there is no clear mechanism for the long-term coexistence of both drug-sensitive and resistant strains at intermediate levels, a ubiquitous pattern seen in surveillance data. Here we show that accounting for structured or spatially-heterogeneous host populations and variability in antibiotic consumption can lead to persistent coexistence over a wide range of treatment coverages, drug efficacies, costs of resistance, and mixing patterns. Moreover, this mechanism can explain other puzzling spatiotemporal features of drug-resistance epidemiology that have received less attention, such as large differences in the prevalence of resistance between geographical regions with similar antibiotic consumption or that neighbor one another. We find that the same amount of antibiotic use can lead to very different levels of resistance depending on how treatment is distributed in a transmission network. We also identify parameter regimes in which population structure alone cannot support coexistence, suggesting the need for other mechanisms to explain the epidemiology of antibiotic resistance. Our analysis identifies key features of host population structure that can be used to assess resistance risk and highlights the need to include spatial or demographic heterogeneity in models to guide resistance management.
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Affiliation(s)
- Madison S. Krieger
- Department of Organismic & Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Carson E. Denison
- Department of Organismic & Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Thayer L. Anderson
- Department of Organismic & Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Martin A. Nowak
- Department of Organismic & Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Alison L. Hill
- Department of Organismic & Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
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Hansen MB, Arpi M, Hedin K, Melander E, Hertz FB, Thorsted AB, Jakobsen HN, Hyllebusk L, Brogaard E, Jensen JN. Antibiotic-prescribing and antibiotic-resistance patterns among elderly citizens residing in two Nordic regions. Infect Dis (Lond) 2020; 52:257-265. [PMID: 31924124 DOI: 10.1080/23744235.2019.1711159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective: The objective of this study was to compare antibiotic-prescribing rates in 2016 and antibiotic-resistance rates in 2017 among citizens aged ≥85 years between the Capital Region in Denmark and the Skåne Region in Sweden, with regards to overall antibiotic use and antibiotics of choice for urinary tract infections (UTIs) and skin and soft tissue infections (SSTIs). Methods: Inhabitants ≥85 year old on the date of prescription during 2016 and residing in the Capital Region or the Skåne Region were included for antibiotic-prescription analyses. Samples from 2017 from residents of the same regions who were ≥85 years old were included for antibiotic-resistance analyses. Antimicrobial use was determined according to the drugs of choice for UTIs and SSTIs in Denmark and Sweden. Students t-tests were used to compare antibiotic prescribing while a Chi-Squared test was performed to compare antibiotic resistance. Results: There was a significantly higher overall prescription rate among citizens ≥85 years in the Capital Region than in the Skåne Region. The same pattern was evident for the antibiotics of choice for UTIs and SSTIs except for clindamycin. Antibiotic resistance against all antibiotics included was more prominent in the Capital Region than in the Skåne Region. Conclusion: Considerable variation in antibiotic prescribing and resistance exists among elderly citizens between these two adjacent Nordic regions. Information and reflection on current practices and resistance patterns may direct attention towards antimicrobial stewardship as a higher priority and may help inform and motivate prescribing behaviours.
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Affiliation(s)
- Matilde Bøgelund Hansen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Magnus Arpi
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Katarina Hedin
- Futurum, Region Jönköping County and Department of Health Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Sciences, Family Medicine, Lund University, Malmö, Sweden
| | - Eva Melander
- Regional Centre of Communicable Disease Control, Skåne Region, Malmö, Sweden.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Frederik Boëtius Hertz
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark.,Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Anne Bonde Thorsted
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Helle Neel Jakobsen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lena Hyllebusk
- Division of Laboratory Medicine, Department of Clinical Microbiology, Lund, Sweden
| | - Emma Brogaard
- Department of Medicines Resource, Skåne Region, Malmö, Sweden
| | - Jette Nygaard Jensen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark.,Task Force for Reducing Hospital Infections, Capital Region of Denmark, Copenhagen, Denmark
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Holm A, Cordoba G, Aabenhus R. Prescription of antibiotics for urinary tract infection in general practice in Denmark. Scand J Prim Health Care 2019; 37:83-89. [PMID: 30689491 PMCID: PMC6452818 DOI: 10.1080/02813432.2019.1569425] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/25/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe and characterize the prescription of antibiotics for urinary tract infection (UTI) in general practice in Denmark and to evaluate compliance with current recommendations. DESIGN National registry-based study Setting: Danish general practice Patients: 267.539 patients who redeemed a prescription for antibiotics with the clinical indication UTI at community pharmacies between July 1st 2012 and June 31st 2013. MAIN OUTCOME MEASURES Antibiotics prescribed for 1) acute lower UTI, 2) acute upper UTI and 3) recurrent UTI presented as amount of prescriptions, number of treatments per 1000 inhabitants per day (TID) and defined daily doses per 1000 inhabitants per day (DID). RESULTS A total of 507.532 prescriptions were issued to 267.539 patients during the one year study period, representing 2.35 DID. Acute lower UTI was the most common reason for prescription of antibiotics (89.5%) followed by recurrent UTI (8.4%). The majority of the prescriptions were issued to people above 60 year old (57.6%). Pivmecillinam was the most commonly prescribed antibiotic in acute lower (45.8%) and acute upper (63.3%) UTI. Trimethroprim was the most commonly prescribed antibiotic in recurrent UTI (45.9%). Prescription of quinolones increased with increasing patient-age (p = <.0001). CONCLUSION Compliance with current Danish recommendations was moderately high. Pivmecillinam is the first line antibiotic for the management of acute lower and upper UTI, and trimethroprim is the first line option of recurrent UTI. A high proportion of the antibiotic prescriptions were issued in the elderly population including a relatively high prescription rate of quinolones. Key points Urinary tract infection (UTI) is a common cause for prescription of antibiotics in general practice Poor compliance in general practice with recommendations for first-line treatment of UTI may increase antibiotic resistance Danish general practitioners are generally compliant with national and regional guidelines for antibiotic treatment of UTI There is high use of antibiotics in the elderly population including a worrisome high use of broad-spectrum antibiotics, such as Quinolones.
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Affiliation(s)
- Anne Holm
- Research Unit for General practice and Department of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Gloria Cordoba
- Research Unit for General practice and Department of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Rune Aabenhus
- Research Unit for General practice and Department of General Practice, University of Copenhagen, Copenhagen, Denmark
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