Antimicrobial prescription practices for outpatients with acute respiratory tract infections: A retrospective, multicenter, medical record-based study
Antimicrobial stewardship for outpatients with acute respiratory tract infections (ARTIs) should be urgently promoted in this era of antimicrobial resistance. Previous large-sample studies were based on administrative data and had limited reliability. We aimed to identify current antimicrobial presc...
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| Veröffentlicht in: | PloS one 2021-11, Vol.16 (11), p.e0259633-e0259633 |
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| creator | Ishida, Tomoharu Hagiya, Hideharu Honda, Hiroyuki Nakano, Yasuhiro Ogawa, Hiroko Obika, Mikako Ueda, Keigo Kataoka, Hitomi Hanayama, Yoshihisa Otsuka, Fumio |
| description | Antimicrobial stewardship for outpatients with acute respiratory tract infections (ARTIs) should be urgently promoted in this era of antimicrobial resistance. Previous large-sample studies were based on administrative data and had limited reliability. We aimed to identify current antimicrobial prescription practices for ARTIs by directly basing on medical records. This multicenter retrospective study was performed from January to December in 2018, at five medical institutes in Japan. We targeted outpatients aged ≥18 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting ARTIs. We divided the eligible cases into three age groups (18-64 years, 65-74 years, and ≥75 years). We defined broad-spectrum antimicrobials as third-generation cephalosporins, macrolides, fluoroquinolones, and faropenem. Primary and secondary outcomes were defined as the proportion of antimicrobial prescriptions for the common cold and other respiratory tract infections, respectively. Totally, data of 3,940 patients were collected. Of 2,914 patients with the common cold, 369 (12.7%) were prescribed antimicrobials. Overall, compared to patients aged ≥75 years (8.5%), those aged 18-64 years (16.6%) and those aged 65-74 years (12.1%) were frequently prescribed antimicrobials for the common cold (odds ratio [95% confidential interval]; 2.15 [1.64-2.82] and 1.49 [1.06-2.09], respectively). However, when limited to cases with a valid diagnosis of the common cold by incorporating clinical data, no statistical difference was observed among the age groups. Broad-spectrum antimicrobials accounted for 90.2% of the antimicrobials used for the common cold. Of 1,026 patients with other respiratory infections, 1,018 (99.2%) were bronchitis, of which antimicrobials were prescribed in 49.9% of the cases. Broad-spectrum antimicrobials were the main agents prescribed, accounting for nearly 90% of prescriptions in all age groups. Our data suggested a favorable practice of antimicrobial prescription for outpatients with ARTIs in terms of prescribing proportions, or quantitative aspect. However, the prescriptions were biased towards broad-spectrum antimicrobials, highlighting the need for further antimicrobial stewardship in the outpatient setting from a qualitative perspective. |
| doi_str_mv | 10.1371/journal.pone.0259633 |
| format | Article |
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Previous large-sample studies were based on administrative data and had limited reliability. We aimed to identify current antimicrobial prescription practices for ARTIs by directly basing on medical records. This multicenter retrospective study was performed from January to December in 2018, at five medical institutes in Japan. We targeted outpatients aged ≥18 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting ARTIs. We divided the eligible cases into three age groups (18-64 years, 65-74 years, and ≥75 years). We defined broad-spectrum antimicrobials as third-generation cephalosporins, macrolides, fluoroquinolones, and faropenem. Primary and secondary outcomes were defined as the proportion of antimicrobial prescriptions for the common cold and other respiratory tract infections, respectively. Totally, data of 3,940 patients were collected. Of 2,914 patients with the common cold, 369 (12.7%) were prescribed antimicrobials. Overall, compared to patients aged ≥75 years (8.5%), those aged 18-64 years (16.6%) and those aged 65-74 years (12.1%) were frequently prescribed antimicrobials for the common cold (odds ratio [95% confidential interval]; 2.15 [1.64-2.82] and 1.49 [1.06-2.09], respectively). However, when limited to cases with a valid diagnosis of the common cold by incorporating clinical data, no statistical difference was observed among the age groups. Broad-spectrum antimicrobials accounted for 90.2% of the antimicrobials used for the common cold. Of 1,026 patients with other respiratory infections, 1,018 (99.2%) were bronchitis, of which antimicrobials were prescribed in 49.9% of the cases. Broad-spectrum antimicrobials were the main agents prescribed, accounting for nearly 90% of prescriptions in all age groups. Our data suggested a favorable practice of antimicrobial prescription for outpatients with ARTIs in terms of prescribing proportions, or quantitative aspect. However, the prescriptions were biased towards broad-spectrum antimicrobials, highlighting the need for further antimicrobial stewardship in the outpatient setting from a qualitative perspective.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0259633</identifier><identifier>PMID: 34767587</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acute Disease - epidemiology ; Adolescent ; Adult ; Age ; Aged ; Aged, 80 and over ; Analysis ; Anti-Bacterial Agents - therapeutic use ; Antimicrobial agents ; Antimicrobial resistance ; Antimicrobial Stewardship - methods ; Biology and Life Sciences ; Bronchitis ; Care and treatment ; Cephalosporins ; Clinics ; Colds ; Common cold ; Dentistry ; Diagnosis ; Drug resistance ; Drug resistance in microorganisms ; Female ; Fluoroquinolones ; Health insurance ; Hospitals ; Humans ; Infections ; Insurance claims ; Japan - epidemiology ; Male ; Medical Records ; Medicine ; Medicine and Health Sciences ; Methods ; Middle Aged ; Outpatient care facilities ; Outpatients ; Patients ; People and Places ; Pharmaceutical sciences ; Prescription writing ; Prescriptions ; Prevention ; Respiratory tract ; Respiratory tract diseases ; Respiratory tract infection ; Respiratory Tract Infections - drug therapy ; Respiratory Tract Infections - epidemiology ; Retrospective Studies ; Risk factors ; Trends ; University graduates ; Young Adult</subject><ispartof>PloS one, 2021-11, Vol.16 (11), p.e0259633-e0259633</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Ishida et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Ishida et al 2021 Ishida et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c685t-8c031e23452c086e7bf756d7017610354cf6f6178dc7cfbacae2c7029ec677423</cites><orcidid>0000-0001-7014-9095 ; 0000-0002-5086-1891</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8589193/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8589193/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34767587$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Clegg, Simon</contributor><creatorcontrib>Ishida, Tomoharu</creatorcontrib><creatorcontrib>Hagiya, Hideharu</creatorcontrib><creatorcontrib>Honda, Hiroyuki</creatorcontrib><creatorcontrib>Nakano, Yasuhiro</creatorcontrib><creatorcontrib>Ogawa, Hiroko</creatorcontrib><creatorcontrib>Obika, Mikako</creatorcontrib><creatorcontrib>Ueda, Keigo</creatorcontrib><creatorcontrib>Kataoka, Hitomi</creatorcontrib><creatorcontrib>Hanayama, Yoshihisa</creatorcontrib><creatorcontrib>Otsuka, Fumio</creatorcontrib><title>Antimicrobial prescription practices for outpatients with acute respiratory tract infections: A retrospective, multicenter, medical record-based study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Antimicrobial stewardship for outpatients with acute respiratory tract infections (ARTIs) should be urgently promoted in this era of antimicrobial resistance. Previous large-sample studies were based on administrative data and had limited reliability. We aimed to identify current antimicrobial prescription practices for ARTIs by directly basing on medical records. This multicenter retrospective study was performed from January to December in 2018, at five medical institutes in Japan. We targeted outpatients aged ≥18 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting ARTIs. We divided the eligible cases into three age groups (18-64 years, 65-74 years, and ≥75 years). We defined broad-spectrum antimicrobials as third-generation cephalosporins, macrolides, fluoroquinolones, and faropenem. Primary and secondary outcomes were defined as the proportion of antimicrobial prescriptions for the common cold and other respiratory tract infections, respectively. Totally, data of 3,940 patients were collected. Of 2,914 patients with the common cold, 369 (12.7%) were prescribed antimicrobials. 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However, the prescriptions were biased towards broad-spectrum antimicrobials, highlighting the need for further antimicrobial stewardship in the outpatient setting from a qualitative perspective.</description><subject>Acute Disease - epidemiology</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antimicrobial agents</subject><subject>Antimicrobial resistance</subject><subject>Antimicrobial Stewardship - methods</subject><subject>Biology and Life Sciences</subject><subject>Bronchitis</subject><subject>Care and treatment</subject><subject>Cephalosporins</subject><subject>Clinics</subject><subject>Colds</subject><subject>Common cold</subject><subject>Dentistry</subject><subject>Diagnosis</subject><subject>Drug resistance</subject><subject>Drug resistance in microorganisms</subject><subject>Female</subject><subject>Fluoroquinolones</subject><subject>Health insurance</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infections</subject><subject>Insurance claims</subject><subject>Japan - 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Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ishida, Tomoharu</au><au>Hagiya, Hideharu</au><au>Honda, Hiroyuki</au><au>Nakano, Yasuhiro</au><au>Ogawa, Hiroko</au><au>Obika, Mikako</au><au>Ueda, Keigo</au><au>Kataoka, Hitomi</au><au>Hanayama, Yoshihisa</au><au>Otsuka, Fumio</au><au>Clegg, Simon</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antimicrobial prescription practices for outpatients with acute respiratory tract infections: A retrospective, multicenter, medical record-based study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-11-12</date><risdate>2021</risdate><volume>16</volume><issue>11</issue><spage>e0259633</spage><epage>e0259633</epage><pages>e0259633-e0259633</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Antimicrobial stewardship for outpatients with acute respiratory tract infections (ARTIs) should be urgently promoted in this era of antimicrobial resistance. Previous large-sample studies were based on administrative data and had limited reliability. We aimed to identify current antimicrobial prescription practices for ARTIs by directly basing on medical records. This multicenter retrospective study was performed from January to December in 2018, at five medical institutes in Japan. We targeted outpatients aged ≥18 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting ARTIs. We divided the eligible cases into three age groups (18-64 years, 65-74 years, and ≥75 years). We defined broad-spectrum antimicrobials as third-generation cephalosporins, macrolides, fluoroquinolones, and faropenem. Primary and secondary outcomes were defined as the proportion of antimicrobial prescriptions for the common cold and other respiratory tract infections, respectively. Totally, data of 3,940 patients were collected. Of 2,914 patients with the common cold, 369 (12.7%) were prescribed antimicrobials. Overall, compared to patients aged ≥75 years (8.5%), those aged 18-64 years (16.6%) and those aged 65-74 years (12.1%) were frequently prescribed antimicrobials for the common cold (odds ratio [95% confidential interval]; 2.15 [1.64-2.82] and 1.49 [1.06-2.09], respectively). However, when limited to cases with a valid diagnosis of the common cold by incorporating clinical data, no statistical difference was observed among the age groups. Broad-spectrum antimicrobials accounted for 90.2% of the antimicrobials used for the common cold. Of 1,026 patients with other respiratory infections, 1,018 (99.2%) were bronchitis, of which antimicrobials were prescribed in 49.9% of the cases. Broad-spectrum antimicrobials were the main agents prescribed, accounting for nearly 90% of prescriptions in all age groups. Our data suggested a favorable practice of antimicrobial prescription for outpatients with ARTIs in terms of prescribing proportions, or quantitative aspect. However, the prescriptions were biased towards broad-spectrum antimicrobials, highlighting the need for further antimicrobial stewardship in the outpatient setting from a qualitative perspective.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>34767587</pmid><doi>10.1371/journal.pone.0259633</doi><tpages>e0259633</tpages><orcidid>https://orcid.org/0000-0001-7014-9095</orcidid><orcidid>https://orcid.org/0000-0002-5086-1891</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-11, Vol.16 (11), p.e0259633-e0259633 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2596927802 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acute Disease - epidemiology Adolescent Adult Age Aged Aged, 80 and over Analysis Anti-Bacterial Agents - therapeutic use Antimicrobial agents Antimicrobial resistance Antimicrobial Stewardship - methods Biology and Life Sciences Bronchitis Care and treatment Cephalosporins Clinics Colds Common cold Dentistry Diagnosis Drug resistance Drug resistance in microorganisms Female Fluoroquinolones Health insurance Hospitals Humans Infections Insurance claims Japan - epidemiology Male Medical Records Medicine Medicine and Health Sciences Methods Middle Aged Outpatient care facilities Outpatients Patients People and Places Pharmaceutical sciences Prescription writing Prescriptions Prevention Respiratory tract Respiratory tract diseases Respiratory tract infection Respiratory Tract Infections - drug therapy Respiratory Tract Infections - epidemiology Retrospective Studies Risk factors Trends University graduates Young Adult |
| title | Antimicrobial prescription practices for outpatients with acute respiratory tract infections: A retrospective, multicenter, medical record-based study |
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