Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2019/11/stewardship-resistance-scan-nov-22-2019
Stewardship / Resistance Scan for Nov 22, 2019
Outpatient prescribing in Tennessee; UNICEF response to AMR
Filed Under:
Antimicrobial Stewardship
[h=3]Tennessee data highlight small group of high antibiotic prescribers[/h] An analysis of outpatient antibiotic prescriptions in Tennessee in 2016 shows that a small number of prescribers were responsible for a "dramatically disproportionate" number of prescriptions, researchers reported today in Infection Control and Hospital Epidemiology.
The retrospective analysis of nearly 8 million prescriptions for outpatient oral antibiotics dispensed at retail pharmacies across the state in 2016 found that there were 1,195 prescriptions per 1,000 total population, and that 50% of the state's total antibiotic prescriptions were written by just 9.3% of prescribers. Of all medical specialties, nurse practitioners wrote the most antibiotic prescriptions (30.6% of all prescriptions), followed by family medicine physicians (15.6%). Urologists had the highest average prescriptions per provider, with 571.
Diving deeper into the high-prescribing group, the researchers found that the specialist groups most likely to be associated with high prescribing were urologists (odds ratio [OR], 3.249; 95% confidence interval [CI], 3.208 to 3.289), nurse practitioners (OR, 2.675; 95% CI, 2.658 to 2.692), dermatologists (OR, 2.396; 95% CI, 2.365 to 2.428), physician assistants (OR, 2.382; 95% CI, 2.364 to 2.400), and pediatricians (OR, 2.340; 95% CI, 2.320 to 2.361). High prescribers were also more likely to have been born in the 1960s (OR, 2.574; 95% CI, 2.531 to 2.618), practice in rural areas, and prescribe more broad-spectrum antibiotics than non-high-prescribing counterparts, including third-generation cephalosporins, macrolides, and extended-spectrum penicillins.
The authors of the study say the data suggest that a stewardship strategy targeting a "small but impactful" group of high prescribers, regardless of specialty, practice location, experience, or gender could significantly reduce outpatient antibiotic prescribing and is potentially a more efficient use of limited resources. But they acknowledge that developing a universal set of interventions deployed easily and relevant to a diverse prescriber group will be a challenge.
"Although we recognize the challenges inherent in this approach, we are hopeful that with continued support and creativity, we can develop and implement successful antimicrobial stewardship interventions for all high prescribers across Tennessee," they write.
Nov 22 Infect Control Hosp Epidemiol abstract
[h=3]UNICEF warns of children's vulnerability to antibiotic resistance[/h] The United Nations Children's Fund (UNICEF) published a technical note today on the threat of antimicrobial resistance (AMR) to child survival, growth, and development.
Calling AMR "perhaps the greatest threat to child survival and health of this generation," the document notes that children are particularly susceptible to diseases caused by drug-resistant microbes because their immune systems aren't fully developed, and that children in low-resource settings with poor sanitation and limited access to healthcare are at even greater risk. As a result, UNICEF warns, AMR has the potential to undo gains in child health achieved by the global health community in recent years.
The technical note identifies three priority areas where UNICEF is currently implementing activities in response to AMR: 1) reducing the incidence of infection; 2) promoting access to, and optimal use of, antimicrobial agents; and 3) increasing awareness and understanding of AMR. It also outlines how different divisions within the agency can strengthen these ongoing efforts to protect children against drug-resistant infections. Among the highlighted efforts are the water, sanitation and hygiene (WASH) program, financial support for increased immunization, the communication for development (C4D) strategy, and support for programs that promote access to diagnostics and appropriate antibiotics while also preventing excessive use.
UNICEF says that because it is a leading voice and advocate for children in 192 countries and territories, and has a reputation as a trusted partner with expertise across sectors and disciplines, it can add significant value to the global AMR response.
Nov 22 UNICEF technical note
Stewardship / Resistance Scan for Nov 22, 2019
Outpatient prescribing in Tennessee; UNICEF response to AMR
Filed Under:
Antimicrobial Stewardship
[h=3]Tennessee data highlight small group of high antibiotic prescribers[/h] An analysis of outpatient antibiotic prescriptions in Tennessee in 2016 shows that a small number of prescribers were responsible for a "dramatically disproportionate" number of prescriptions, researchers reported today in Infection Control and Hospital Epidemiology.
The retrospective analysis of nearly 8 million prescriptions for outpatient oral antibiotics dispensed at retail pharmacies across the state in 2016 found that there were 1,195 prescriptions per 1,000 total population, and that 50% of the state's total antibiotic prescriptions were written by just 9.3% of prescribers. Of all medical specialties, nurse practitioners wrote the most antibiotic prescriptions (30.6% of all prescriptions), followed by family medicine physicians (15.6%). Urologists had the highest average prescriptions per provider, with 571.
Diving deeper into the high-prescribing group, the researchers found that the specialist groups most likely to be associated with high prescribing were urologists (odds ratio [OR], 3.249; 95% confidence interval [CI], 3.208 to 3.289), nurse practitioners (OR, 2.675; 95% CI, 2.658 to 2.692), dermatologists (OR, 2.396; 95% CI, 2.365 to 2.428), physician assistants (OR, 2.382; 95% CI, 2.364 to 2.400), and pediatricians (OR, 2.340; 95% CI, 2.320 to 2.361). High prescribers were also more likely to have been born in the 1960s (OR, 2.574; 95% CI, 2.531 to 2.618), practice in rural areas, and prescribe more broad-spectrum antibiotics than non-high-prescribing counterparts, including third-generation cephalosporins, macrolides, and extended-spectrum penicillins.
The authors of the study say the data suggest that a stewardship strategy targeting a "small but impactful" group of high prescribers, regardless of specialty, practice location, experience, or gender could significantly reduce outpatient antibiotic prescribing and is potentially a more efficient use of limited resources. But they acknowledge that developing a universal set of interventions deployed easily and relevant to a diverse prescriber group will be a challenge.
"Although we recognize the challenges inherent in this approach, we are hopeful that with continued support and creativity, we can develop and implement successful antimicrobial stewardship interventions for all high prescribers across Tennessee," they write.
Nov 22 Infect Control Hosp Epidemiol abstract
[h=3]UNICEF warns of children's vulnerability to antibiotic resistance[/h] The United Nations Children's Fund (UNICEF) published a technical note today on the threat of antimicrobial resistance (AMR) to child survival, growth, and development.
Calling AMR "perhaps the greatest threat to child survival and health of this generation," the document notes that children are particularly susceptible to diseases caused by drug-resistant microbes because their immune systems aren't fully developed, and that children in low-resource settings with poor sanitation and limited access to healthcare are at even greater risk. As a result, UNICEF warns, AMR has the potential to undo gains in child health achieved by the global health community in recent years.
The technical note identifies three priority areas where UNICEF is currently implementing activities in response to AMR: 1) reducing the incidence of infection; 2) promoting access to, and optimal use of, antimicrobial agents; and 3) increasing awareness and understanding of AMR. It also outlines how different divisions within the agency can strengthen these ongoing efforts to protect children against drug-resistant infections. Among the highlighted efforts are the water, sanitation and hygiene (WASH) program, financial support for increased immunization, the communication for development (C4D) strategy, and support for programs that promote access to diagnostics and appropriate antibiotics while also preventing excessive use.
UNICEF says that because it is a leading voice and advocate for children in 192 countries and territories, and has a reputation as a trusted partner with expertise across sectors and disciplines, it can add significant value to the global AMR response.
Nov 22 UNICEF technical note