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Haque MA, Nath ND, Johnston TV, Haruna S, Ahn J, Ovissipour R, Ku S. Harnessing biotechnology for penicillin production: Opportunities and environmental considerations. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 946:174236. [PMID: 38942308 DOI: 10.1016/j.scitotenv.2024.174236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
Since the discovery of antibiotics, penicillin has remained the top choice in clinical medicine. With continuous advancements in biotechnology, penicillin production has become cost-effective and efficient. Genetic engineering techniques have been employed to enhance biosynthetic pathways, leading to the production of new penicillin derivatives with improved properties and increased efficacy against antibiotic-resistant pathogens. Advances in bioreactor design, media formulation, and process optimization have contributed to higher yields, reduced production costs, and increased penicillin accessibility. While biotechnological advances have clearly benefited the global production of this life-saving drug, they have also created challenges in terms of waste management. Production fermentation broths from industries contain residual antibiotics, by-products, and other contaminants that pose direct environmental threats, while increased global consumption intensifies the risk of antimicrobial resistance in both the environment and living organisms. The current geographical and spatial distribution of antibiotic and penicillin consumption dramatically reveals a worldwide threat. These challenges are being addressed through the development of novel waste management techniques. Efforts are aimed at both upstream and downstream processing of antibiotic and penicillin production to minimize costs and improve yield efficiency while lowering the overall environmental impact. Yield optimization using artificial intelligence (AI), along with biological and chemical treatment of waste, is also being explored to reduce adverse impacts. The implementation of strict regulatory frameworks and guidelines is also essential to ensure proper management and disposal of penicillin production waste. This review is novel because it explores the key remaining challenges in antibiotic development, the scope of machine learning tools such as Quantitative Structure-Activity Relationship (QSAR) in modern biotechnology-driven production, improved waste management for antibiotics, discovering alternative path to reducing antibiotic use in agriculture through alternative meat production, addressing current practices, and offering effective recommendations.
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Affiliation(s)
- Md Ariful Haque
- Department of Food Science and Technology, Texas A&M University, College Station, USA.
| | - Nirmalendu Deb Nath
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, USA.
| | - Tony Vaughn Johnston
- Fermentation Science Program, School of Agriculture, College of Basic and Applied Sciences, Middle Tennessee State University, Murfreesboro, USA.
| | - Samuel Haruna
- Fermentation Science Program, School of Agriculture, College of Basic and Applied Sciences, Middle Tennessee State University, Murfreesboro, USA.
| | - Jaehyun Ahn
- Department of Food Science and Technology, Texas A&M University, College Station, USA.
| | - Reza Ovissipour
- Department of Food Science and Technology, Texas A&M University, College Station, USA.
| | - Seockmo Ku
- Department of Food Science and Technology, Texas A&M University, College Station, USA.
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Aubrey-Basler K, Bursey K, Pike A, Penney C, Furlong B, Howells M, Al-Obaid H, Rourke J, Asghari S, Hall A. Interventions to improve primary healthcare in rural settings: A scoping review. PLoS One 2024; 19:e0305516. [PMID: 38990801 PMCID: PMC11239038 DOI: 10.1371/journal.pone.0305516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Residents of rural areas have poorer health status, less healthy behaviours and higher mortality than urban dwellers, issues which are commonly addressed in primary care. Strengthening primary care may be an important tool to improve the health status of rural populations. OBJECTIVE Synthesize and categorize studies that examine interventions to improve rural primary care. ELIGIBILITY CRITERIA Experimental or observational studies published between January 1, 1996 and December 2022 that include an historical or concurrent control comparison. SOURCES OF EVIDENCE Pubmed, CINAHL, Cochrane Library, Embase. CHARTING METHODS We extracted and charted data by broad category (quality, access and efficiency), study design, country of origin, publication year, aim, health condition and type of intervention studied. We assigned multiple categories to a study where relevant. RESULTS 372 papers met our inclusion criteria, divided among quality (82%), access (20%) and efficiency (13%) categories. A majority of papers were completed in the USA (40%), Australia (15%), China (7%) or Canada (6%). 35 (9%) papers came from countries in Africa. The most common study design was an uncontrolled before-and-after comparison (32%) and only 24% of studies used randomized designs. The number of publications each year has increased markedly over the study period from 1-2/year in 1997-99 to a peak of 49 papers in 2017. CONCLUSIONS Despite substantial inequity in health outcomes associated with rural living, very little attention is paid to rural primary care in the scientific literature. Very few studies of rural primary care use randomized designs.
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Affiliation(s)
- Kris Aubrey-Basler
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Krystal Bursey
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Andrea Pike
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Carla Penney
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Bradley Furlong
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Mark Howells
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Harith Al-Obaid
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - James Rourke
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Amanda Hall
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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Stevens ER, Feldstein D, Jones S, Twan C, Cui X, Hess R, Kim EJ, Richardson S, Malik FM, Tasneem S, Henning N, Xu L, Mann DM. Ambulatory antibiotic prescription rates for acute respiratory infection rebound two years after the start of the COVID-19 pandemic. PLoS One 2024; 19:e0306195. [PMID: 38917147 PMCID: PMC11198751 DOI: 10.1371/journal.pone.0306195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, acute respiratory infection (ARI) antibiotic prescribing in ambulatory care markedly decreased. It is unclear if antibiotic prescription rates will remain lowered. METHODS We used trend analyses of antibiotics prescribed during and after the first wave of COVID-19 to determine whether ARI antibiotic prescribing rates in ambulatory care have remained suppressed compared to pre-COVID-19 levels. Retrospective data was used from patients with ARI or UTI diagnosis code(s) for their encounter from 298 primary care and 66 urgent care practices within four academic health systems in New York, Wisconsin, and Utah between January 2017 and June 2022. The primary measures included antibiotic prescriptions per 100 non-COVID ARI encounters, encounter volume, prescribing trends, and change from expected trend. RESULTS At baseline, during and after the first wave, the overall ARI antibiotic prescribing rates were 54.7, 38.5, and 54.7 prescriptions per 100 encounters, respectively. ARI antibiotic prescription rates saw a statistically significant decline after COVID-19 onset (step change -15.2, 95% CI: -19.6 to -4.8). During the first wave, encounter volume decreased 29.4% and, after the first wave, remained decreased by 188%. After the first wave, ARI antibiotic prescription rates were no longer significantly suppressed from baseline (step change 0.01, 95% CI: -6.3 to 6.2). There was no significant difference between UTI antibiotic prescription rates at baseline versus the end of the observation period. CONCLUSIONS The decline in ARI antibiotic prescribing observed after the onset of COVID-19 was temporary, not mirrored in UTI antibiotic prescribing, and does not represent a long-term change in clinician prescribing behaviors. During a period of heightened awareness of a viral cause of ARI, a substantial and clinically meaningful decrease in clinician antibiotic prescribing was observed. Future efforts in antibiotic stewardship may benefit from continued study of factors leading to this reduction and rebound in prescribing rates.
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Affiliation(s)
- Elizabeth R. Stevens
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - David Feldstein
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Simon Jones
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Chelsea Twan
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Xingwei Cui
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, United States of America
| | - Eun Ji Kim
- Northwell, New Hyde Park, New York, United States of America
| | - Safiya Richardson
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Fatima M. Malik
- Northwell, New Hyde Park, New York, United States of America
| | - Sumaiya Tasneem
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Natalie Henning
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Lynn Xu
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Devin M. Mann
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
- Medical Center Information Technology, NYU Langone Health, New York, New York, United States of America
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Ayorinde A, Ghosh I, Shaikh J, Adetunji V, Brown A, Jordan M, Gilham E, Todkill D, Ashiru-Oredope D. Improving healthcare professionals' interactions with patients to tackle antimicrobial resistance: a systematic review of interventions, barriers, and facilitators. Front Public Health 2024; 12:1359790. [PMID: 38841670 PMCID: PMC11150712 DOI: 10.3389/fpubh.2024.1359790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/30/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Antimicrobial resistance (AMR) is a major public health threat. With the growing emphasis on patient-centred care/ shared decision making, it is important for healthcare professionals' (HCPs) who prescribe, dispense, administer and/or monitor antimicrobials to be adequately equipped to facilitate appropriate antimicrobial use. We systematically identified existing interventions which aim to improve HCPs interaction with patients and examined barriers and facilitators of appropriate the use of such interventions and appropriate antimicrobial use among both HCPs and patientsantimicrobial use while using these interventions. Methods We searched MEDLINE, EMBASE, Web of Science, Google Scholar, and internet (via Google search engine). We included primary studies, published in English from 2010 to 2023 [PROSPERO (CRD42023395642)]. The protocol was preregistered with PROSPERO (CRD42023395642). We performed quality assessment using mixed methods appraisal tool. We applied narrative synthesis and used the COM-B (Capability, Opportunity, Motivation -Behaviour) as a theoretical framework for barriers and facilitators at HCP and patient levels. Results Of 9,172 citations retrieved from database searches, From 4,979 citations remained after removal of duplicates. We included 59 studies spanning over 13 countries. Interventions often involved multiple components beyond HCPs' interaction with patients. From 24 studies reporting barriers and facilitators, we identified issues relating to capability (such as, knowledge/understanding about AMR, diagnostic uncertainties, awareness of interventions and forgetfulness); opportunity (such as, time constraint and intervention accessibility) and motivation (such as, patient's desire for antibiotics and fear of litigation). Conclusion The findings of this review should be considered by intervention designers/adopters and policy makers to improve utilisation and effectiveness.
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Affiliation(s)
- Abimbola Ayorinde
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Iman Ghosh
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Junaid Shaikh
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Victoria Adetunji
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Anna Brown
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Mary Jordan
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Ellie Gilham
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Daniel Todkill
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Diane Ashiru-Oredope
- UK Health Security Agency, London, United Kingdom
- School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
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O'Neill S, Begg S, Hyett N, Spelten E. Primary Health Care Interventions for Potentially Preventable Ear, Nose, and Throat Conditions in Rural and Remote Areas: A Systematic Review. EAR, NOSE & THROAT JOURNAL 2024:1455613241245198. [PMID: 38646793 DOI: 10.1177/01455613241245198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Background:Primary and secondary level preventive primary health care programs providing early detection and timely management of ear, nose, and throat (ENT) conditions in rural and remote regions are fundamental to preventing downstream impacts on health, social, and educational outcomes. However, the range and quality of evidence is yet to be reviewed. Objectives: The study objectives were to identify and synthesize the evidence of primary health care interventions for detection and management of ENT conditions in rural and remote areas, and evaluate the quality of the research and effectiveness of interventions. Methods: A systematic literature search of 6 databases (February 2023). The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, and the quality appraisal of studies was evaluated using the Mixed Methods Appraisal Tool (initial screening questions: Are there clear research questions? Do the collected data allow to address the research questions?). Results: Ten studies met the inclusion criteria. The results describe interventions for detection and management of respiratory tract infections, otitis media, and ear disease in primary health care settings. No studies met the inclusion criteria for tonsillitis. The role of community-based programs and allied health workers in the detection and management of ENT conditions was found to be effective in rural and remote regions. Only 2 of the studies met the screening criteria for quality appraisal. Conclusions: The study findings may inform future programs and policy development to address detection and management of ENT conditions in rural and remote primary care settings, and supports the need for further research on innovative models of care targeting potentially preventable hospitalizations through primary and secondary level prevention.
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Affiliation(s)
- Susan O'Neill
- Department of Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Stephen Begg
- Department of Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Nerida Hyett
- Murray Primary Health Network, Bendigo, VIC, Australia
| | - Evelien Spelten
- Department of Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
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Sutton KF, Ashley LW. Antimicrobial resistance in the United States: Origins and future directions. Epidemiol Infect 2024; 152:e33. [PMID: 38343135 PMCID: PMC10894903 DOI: 10.1017/s0950268824000244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
Antimicrobial resistance (AMR) remains a critical public health problem that pervades hospitals and health systems worldwide. The ongoing AMR crisis is not only concerning for patient care but also healthcare delivery and quality. This article outlines key components of the origins of AMR in the United States and how it presents across the American healthcare system. Numerous factors contributed to the crisis, including agricultural antibiotic use, wasteful prescribing practices in health care, conflicting behaviours among patients and clinicians, patient demand and satisfaction, and payment and reimbursement models that incentivize inappropriate antibiotic use. To combat AMR, clinicians, healthcare professionals, and legislators must continue to promote and implement innovative solutions, including antibiotic stewardship programmes (ASPs), hand hygiene protocols, ample supply of personal protective equipment (PPE), standardized treatment guidelines for antibiotic prescribing, clinician and patient educational programmes, and health policy initiatives. With the rising prevalence of multi-drug resistant bacterial infections, AMR must become a greater priority to policymakers and healthcare stakeholders.
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Affiliation(s)
- Kent F. Sutton
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Lucas W. Ashley
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
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McNicholas M, Hooper G. Effects of patient education to reduce antibiotic prescribing rates for upper respiratory infections in primary care. Fam Pract 2022; 39:1-5. [PMID: 34173645 DOI: 10.1093/fampra/cmab054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antibiotic stewardship programs in primary care are necessary to reduce the estimated 30% of inappropriately written antibiotic prescriptions and reduce the spread of microbial resistance. Most programs focus on educating prescribers, but this intervention focused on educating patients. OBJECTIVES To develop and implement an antibiotic stewardship program in a primary care clinic to educate patients with upper respiratory infections (URIs) about antibiotic use and to assess the effectiveness of the program through antibiotic prescribing rates. METHODS Using materials from the Centers for Disease Control and Prevention (CDC) Be Antibiotics Aware program, posters on antibiotic use were placed in the exam rooms, graphic interchange formats (GIFs) and memes were displayed on exam room monitors, patient-provider discussions on antibiotic use were held, and written information for symptom management of URIs was provided. Retrospective chart reviews were conducted to assess antibiotic prescribing rates by four prescribers in a primary care clinic for September and October 2020 and compared to the same time period for 2019. RESULTS The rate of total antibiotic prescriptions decreased by 12.6% (P = 0.044) and the rate of repeat consultation antibiotic prescriptions decreased by 12.2% (P = 0.007), whereas the rate of antibiotics prescribed at the time of the visit remained unchanged (P = 0.937). All providers had decreased rates of antibiotic prescribing after the intervention. CONCLUSION Results of this study indicate that providing education about antibiotics to patients in need of treatment for URIs may reduce the rate of antibiotics prescribed in primary care; however, further research is warranted.
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Affiliation(s)
| | - Gwendolyn Hooper
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
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Yau JW, Thor SM, Tsai D, Speare T, Rissel C. Antimicrobial stewardship in rural and remote primary health care: a narrative review. Antimicrob Resist Infect Control 2021; 10:105. [PMID: 34256853 PMCID: PMC8278763 DOI: 10.1186/s13756-021-00964-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/28/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is an emerging problem worldwide and poses a significant threat to human health. Antimicrobial stewardship programmes are being implemented in health systems globally, primarily in hospitals, to address the growing threat of antimicrobial resistance. Despite the significance of primary health care services in providing health care to communities, antimicrobial stewardship programmes are not well established in this sector, especially in rural and remote settings. This narrative review aims to identify in rural and remote primary health care settings the (1) correlation of antimicrobial resistance with antibiotic prescribing and volume of antibiotic use, (2) appropriateness of antimicrobial prescribing, (3) risk factors associated with inappropriate use/prescribing of antibiotics, and (4) effective antimicrobial stewardship strategies. METHODS The international literature was searched for English only articles between 2000 and 2020 using specified keywords. Seven electronic databases were searched: Scopus, Cochrane, Embase, CINAHL, PubMed, Ovid Medline and Ovid Emcare. Publication screening and analysis were conducted using Joanna Briggs Institute systematic review tools. RESULTS Fifty-one eligible articles were identified. Inappropriate and excessive antimicrobial prescribing and use directly led to increases in antimicrobial resistance. Increasing rurality of practice is associated with disproportionally higher rates of inappropriate prescribing compared to those in metropolitan areas. Physician knowledge, attitude and behaviour play important roles in mediating antimicrobial prescribing, with strong intrinsic and extrinsic influences including patient factors. Antimicrobial stewardship strategies in rural and remote primary health care settings focus on health care provider and patient education, clinician support systems, utility of antimicrobial resistance surveillance, and policy changes. Results of these interventions were generally positive with decreased antimicrobial resistance rates and improved appropriateness of antimicrobial prescribing. CONCLUSIONS Inappropriate prescribing and excessive use of antimicrobials are an important contributor to the increasing resistance towards antimicrobial agents particularly in rural and remote primary health care. Antimicrobial stewardship programmes in the form of education, clinical support, surveillance, and policies have been mostly successful in reducing prescribing rates and inappropriate prescriptions. The narrative review highlighted the need for longer interventions to assess changes in antimicrobial resistance rates. The review also identified a lack of differentiation between rural and remote contexts and Indigenous health was inadequately addressed. Future research should have a greater focus on effective interventional components and patient perspectives.
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Affiliation(s)
- Jun Wern Yau
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia
| | - Sze Mun Thor
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500, Bandar Sunway, Malaysia
| | - Danny Tsai
- Flinders University- Rural and Remote Health NT, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT, 0810, Australia.,Alice Springs Hospital, Central Australian Health Service, Alice Springs, NT, 0870, Australia.,University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Tobias Speare
- Flinders University- Rural and Remote Health NT, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT, 0810, Australia.,Alice Springs Hospital, Central Australian Health Service, Alice Springs, NT, 0870, Australia
| | - Chris Rissel
- Flinders University- Rural and Remote Health NT, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT, 0810, Australia.
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Wattles BA, Vidwan NK, Feygin Y, Jawad KS, Creel LM, Smith MJ. Antibiotic prescribing to Kentucky Medicaid children, 2012-2017: Prescribing is higher in rural areas. THE JOURNAL OF RURAL HEALTH : OFFICIAL JOURNAL OF THE AMERICAN RURAL HEALTH ASSOCIATION AND THE NATIONAL RURAL HEALTH CARE ASSOCIATION 2021; 38:427-432. [PMID: 33978987 DOI: 10.1111/jrh.12584] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Antibiotic resistance is a major public health threat. Antibiotic use is the main driver of resistance, with children and the state of Kentucky having particularly high rates of outpatient antibiotic prescribing. The purpose of this study was to describe patient and provider characteristics associated with pediatric antibiotic use in Kentucky Medicaid children. METHODS We used Medicaid prescription claims data from 2012 to 2017 to describe patterns of pediatric antibiotic receipt in Kentucky. Patient and provider variables were analyzed to identify variations in prescribing. FINDINGS Children who were female, less than 2 years old, White, and living in a rural area had consistently higher rates of antibiotic prescriptions. There was significant geographic variability in prescribing, with children in Eastern Kentucky receiving more than 3 courses of antibiotics a year. Most antibiotic prescriptions for children were written by general practitioners and nurse practitioners rather than pediatricians. CONCLUSION These findings support the need for extensive antibiotic stewardship efforts inclusive of rural outpatient practices.
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Affiliation(s)
- Bethany A Wattles
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Navjyot K Vidwan
- Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Yana Feygin
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Kahir S Jawad
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Liza M Creel
- School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Michael J Smith
- Duke University Medical Center, Pediatric Infectious Diseases, Durham, North Carolina, USA
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10
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Antibiotic stewardship: Improving patient-centered right care in urgent care using a shared decision aid and 5 Ds tool. J Am Assoc Nurse Pract 2020; 33:1265-1272. [PMID: 33038113 DOI: 10.1097/jxx.0000000000000511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Overuse of antibiotics leads to antibiotic resistance, costing $35 billion and causing approximately 23,000 deaths in the United States annually. Antibiotic stewardship is important in urgent care centers to prevent antibiotic resistance. LOCAL PROBLEM Providers prescribed antibiotics to 80% of patients with viral conditions at this urgent care center. The aim of this quality improvement (QI) project was to improve right care for patients of 65 years and younger with upper respiratory infections and/or head, ears, nose, or throat viral illnesses presenting to urgent care from 36.2% to 80% within 90 days. METHODS Four rapid Plan-Do-Study-Act cycles were performed every two weeks. Four concurrent focus areas were used for team and patient engagement, antibiotic prescribing, and tracking right care. INTERVENTIONS There were four core interventions. These included biweekly team meetings, a shared decision aid (SDA), an antibiotic prescribing 5 Ds tool, and a case management log. RESULTS Use of the SDA improved patient engagement from 33% to 93%. The 5 Ds tool improved proper prescribing from 20% to 95%. Pediatric acute otitis media had the greatest improvement, with the proper diagnosis and the use of watchful waiting, delaying the filling of an antibiotic prescription. CONCLUSION Antibiotic stewardship and standardization of prescribing were improved in urgent care with the use of the 5 Ds tool. This QI project can be replicated for use in urgent care centers for compliance with the Joint Commission standards required.
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