Outpatient Antibiotic Prescribing Patterns for Adult End-Stage Renal Disease Patients in New York State
Recommended Citation
Coritsidis GN, Yaphe S, Rahkman I, Lubowski T, Munro C, Kuang Lee T, Stern A, and Bhat P. Outpatient Antibiotic Prescribing Patterns for Adult End-Stage Renal Disease Patients in New York State. Clin Infect Dis 2020.
Document Type
Article
Publication Date
12-5-2020
Publication Title
Clinical infectious diseases
Abstract
IMPORTANCE: Infections are important complications of end-stage renal disease (ESRD) with few studies having investigated oral antibiotic use. Inappropriate antibiotic prescribing can contribute to multi-drug resistant organisms (MDRO) and Clostridioides difficile (CDI) infections seen in ESRD. This study investigates antibiotic prescribing practices in ESRD across New York State (NYS).
METHODS: Retrospective case-control study from 2016 to 2017 of NYS ESRD and non-ESRD patients analyzing Medicare part B billing codes, 7 days before and 3 days after part D claims. Frequencies of each infection, each antibiotic, dosages, and the antibiotics associated with infections were assessed using chi-square analysis. A NYS small dialysis organization comprising approximately 2200 patients was also analyzed. Outcomes measured were the frequencies of infections and of each antibiotic prescribed. Incidence measures included antibiotics/1000 and individuals receiving antibiotics/1000.
RESULTS: 48,100 infections were treated in 35,369 ESRD patients and 2,544,443 infections treated in 3,777,314 non-ESRD patients. ESRD patients were younger, male, and African American. ESRD and non-ESRD patients receiving antibiotics was 520.29/1000 and 296.48/1000, respectively (p<0.05). The prescription incidence was 1359.95/1000 ESRD vs 673.61/1000 non-ESRD patients. In 36%, trimethoprim-sulfamethoxazole dosage was elevated by current ESRD guidelines. Top infectious categories included non-specific symptoms, skin, and respiratory for ESRD; and respiratory, nonspecific symptoms, and genitourinary in non-ESRD.
CONCLUSIONS: This study Identifies issues with appropriate antibiotic usage stressing the importance of antibiotic education to nephrologist and non-nephrologist providers. It provides support for outpatient antibiotic stewardship programs.
PubMed ID
33277995
ePublication
ePub ahead of print
