背景:缺乏及时、详细的抗生素使用数据限制了门诊抗生素管理工作.在大型综合卫生系统中,跟踪门诊护理场所和急诊科(ED)的抗生素使用情况。方法:这是一项回顾性队列分析,从2019年6月1日至2020年5月31日,比较所有具有ICD-10诊断代码的膀胱炎患者的抗生素处方,中耳炎,咽炎,鼻窦炎,俄亥俄州东北部和佛罗里达州东南部的五个门诊护理部门的上呼吸道感染(URTI):ED,紧急护理(UC),按需远程医疗(TEL),儿科(PED),初级保健(PC)。结果:总共纳入了261,947次相遇(ED:56,766,UC:92,749,TEL:8,783,PED:29,151,PC:74,498),用于治疗膀胱炎(30,932),中耳炎(22,094),咽炎(59,964),鼻窦炎(53,693),或URTI(95,264)。人口为63%的女性,中位年龄为34.2岁[12.8-56.3]。总共有17%的患者记录了青霉素过敏,18%的咽炎患者接受了A组链球菌(GAS)检测。44%的患者服用抗生素(ED:21,746[38%],UC:45,652[49%],TEL:4,622[53%],PED:10,909[37%],PC:33,547[45%];P<0.001)。在65%的遭遇中使用了指南一致的抗生素(ED:14,338[66%],UC:31,532[69%],TEL:3,869[84%],PED:8,212[75%],PC:17,263[51%];P<0.001)。结论:观察到的抗生素和指南一致的抗生素处方率与全国公开的门诊抗生素处方率相似。抗生素处方的可变性证明了有针对性的门诊管理工作的机会。及时的抗生素跟踪工具可以促进门诊抗生素管理活动。
Background: Lack of access to timely, detailed antibiotic use data has limited ambulatory antibiotic stewardship efforts. Antibiotic utilization is tracked across ambulatory care sites and emergency departments (ED) within a large integrated health system. Methods: This is a retrospective cohort analysis from June 1, 2019 to May 31, 2020 comparing antibiotic prescribing for all patients with ICD-10 diagnosis codes for cystitis, otitis media, pharyngitis, sinusitis, and upper respiratory tract infections (URTIs) among five ambulatory care departments across northeast Ohio and southeast Florida locations: ED, Urgent Care (UC), On-Demand Telehealth (TEL), Pediatrics (PED), and Primary Care (PC). Results: A total of 261,947 encounters were included (ED:56,766, UC:92,749, TEL:8,783, PED:29,151, PC:74,498) for the treatment of cystitis (30,932), otitis media (22,094), pharyngitis (59,964), sinusitis (53,693), or URTI (95,264). The population was 63% female with a median age of 34.2 years [12.8-56.3]. A total of 17% of patients had documented penicillin allergies and 18% of patients with pharyngitis received Group A Streptococcus (GAS) testing. Antibiotics were prescribed in 44% of encounters (ED:21,746 [38%], UC:45,652 [49%], TEL:4,622 [53%], PED:10,909 [37%], PC:33,547 [45%]; P < 0.001). Guideline concordant antibiotics were prescribed in 65% of encounters (ED:14,338 [66%], UC:31,532 [69%], TEL:3,869 [84%], PED:8,212 [75%], PC:17,263 [51%]; P < 0.001). Conclusions: Observed rates of antibiotic and guideline concordant antibiotic prescribing were similar to national published rates of antibiotic prescribing in the ambulatory setting. The variability in antibiotic prescribing demonstrates opportunities for targeted outpatient stewardship efforts. Timely antibiotic tracking tools can facilitate ambulatory antimicrobial stewardship activities.