EDs, urgent care centers ‘easy targets’ for antibiotic stewardship
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More than 40% of antibiotics prescribed in Veterans Health Administration EDs and urgent care centers for acute respiratory infections were prescribed with an inappropriate indication, according to a study.
Researchers said the findings show “there are major opportunities to improve management of both viral and potentially bacterial” acute respiratory infections (ARIs) within the Veterans Health Administration (VHA).
“I started this study because I wanted to understand other aspects of antibiotic-prescribing in ambulatory care settings,” Daniel J. Livorsi, MD, MSc, an assistant professor of medicine at the University of Iowa Carver College of Medicine and infectious disease specialist in the Iowa City Veterans Affairs Health Care System, told Healio. “There has been a lot of focus on the unnecessary use of antibiotics for viral infections but not as much focus on how well antibiotics are used when they're actually indicated.”
To evaluate antibiotic prescribing for viral and potentially bacterial acute ARIs among inpatients seen at EDs and urgent care centers (UCCs), Livorsi and colleagues performed a retrospective cohort study that included all ED and UCC visits by patients who were not hospitalized and were seen from 2016 to 2018 in the VHA. According to the study, there were 3,182,926 patient visits across 129 sites 80.7% in EDs and 19.3% in UCCs.
The study revealed that antibiotics were prescribed during 608,289 (19.1%) visits, including 42.7% with an “inappropriate indication.” According to the study, for potentially bacterial ARIs, guideline-consistent management varied across clinicians (36.2%; interquartile range [IQR] = 26-52.7) and sites (38.2%; IQR = 31.7-49.4). For viral ARIs, management consistent with guidelines varied across clinicians (46.2%; IQR = 24.1-68.6) and sites (40.0%; IQR = 30.4-59.3).
The researchers added that among both clinicians and sites, they detected weak correlations between guideline-consistent management for viral and potentially bacterial ARIs.
“The take-home message is that there are some easy targets for antibiotic stewardship in EDs and urgent care clinics. In line with prior work, our study showed that one of these targets is discouraging the use of antibiotics for viral respiratory tract infections,” Livorsi said.
“Our study also showed that additional targets are using the shortest effective duration of therapy for suspected cases of bacterial sinusitis and pneumonia,” he said. “In our study, these conditions were frequently treated with courses of antibiotics that were excessively long. Finally, there is a need to improve empiric antibiotic selection for common bacterial respiratory tract infections, such as pneumonia.”
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