Unnecessary Antibiotic Use Linked to Lack of Testing and Unspecified Diagnosis

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The unnecessary use of antibiotics is associated with an unspecified diagnosis and a lack of microbial testing.
The unnecessary use of antibiotics is associated with an unspecified diagnosis and a lack of microbial testing.

The unnecessary use of antibiotics is associated with an unspecified diagnosis and a lack of microbial testing, according to study findings published in Clinical Infectious Diseases.

Resistance to antibiotics has become a global concern. The primary goal of antimicrobial stewardship programs is to prevent the continuing emergence of multidrug-resistant pathogens by reducing the use of antimicrobial therapy. In a prospective, multicenter study, researchers assessed all curative antibiotic therapies that had been prescribed over 2 consecutive days.  Unnecessary use of antibiotics was defined as the “recognition of non-infectious syndromes, non-bacterial infections, use of redundant antimicrobials, and continuation of empirical broad-spectrum antimicrobials.

A total of 453 antibiotic therapies were analyzed at 17 different centers, and infectious disease was the reason for hospitalization in 201 cases (44%). Of these cases, 104 (23%) had an unspecified diagnosis of infection, and microbial samples were obtained in approximately two-thirds (n=296 cases, 65%) of cases. A pathogen was isolated in 156 cases (53%). Overall, an unspecified diagnosis was associated with the lack of a microbial sample (56/104 (54%) vs 240/349 (69%), P=.005) and 158 (35%) non-infectious syndromes were detected. The unnecessary use of antibiotics occurred in 169 cases (37%) and was associated with non-infectious syndromes in 106 cases. Multivariate analysis showed that the modifiable risk factors for unnecessary use of antibiotics were unspecified diagnosis (adjusted odds ratio [aOR], 1.83; 95% CI, 1.04-3.20) and the absence of obtaining a blood culture (aOR, 5.26; 95% CI, 2.56-10.00).

The researchers noted the limitations of this study are related to the methodology. Since it was a real-time prospective audit using computerized medical records, the duration of therapy could not be assessed, and that is also a criterion for unnecessary use of antibiotics. “Moreover, the 2-day duration may have led to microbiological testing being considered to be non-contributing due to a lack of overview,” the investigators wrote.

Reference

Roger PM, Montera E, Lesselingue D, et al. Risk factors for unnecessary antibiotic therapy: a major role for clinical management [published online October 31, 2018]. Clin Infect Dis. doi:10.1093/cid/ciy921

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