Loading…
Antibiotic prescribing in general medical and surgical specialties: a prospective cohort study
Qualitative work has described the differences in prescribing practice across medical and surgical specialties. This study aimed to understand if specialty impacts quantitative measures of prescribing practice. We prospectively analysed the antibiotic prescribing across general medical and surgical...
Saved in:
| Published in: | Antimicrobial resistance & infection control 2019-09, Vol.8 (1), p.151-151, Article 151 |
|---|---|
| Main Authors: | , , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c591t-1a61fab97fc607678533476c3eeb3c6c33c8b4b1a7f95e03ae2db3ebfc6602d13 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c591t-1a61fab97fc607678533476c3eeb3c6c33c8b4b1a7f95e03ae2db3ebfc6602d13 |
| container_end_page | 151 |
| container_issue | 1 |
| container_start_page | 151 |
| container_title | Antimicrobial resistance & infection control |
| container_volume | 8 |
| creator | Charani, E de Barra, E Rawson, T M Gill, D Gilchrist, M Naylor, N R Holmes, A H |
| description | Qualitative work has described the differences in prescribing practice across medical and surgical specialties. This study aimed to understand if specialty impacts quantitative measures of prescribing practice.
We prospectively analysed the antibiotic prescribing across general medical and surgical teams for acutely admitted patients. Over a 12-month period (June 2016 - May 2017) 659 patients (362 medical, 297 surgical) were followed for the duration of their hospital stay. Antibiotic prescribing across these cohorts was assessed using Chi-squared or Wilcoxon rank-sum, depending on normality of data. The t-test was used to compare age and length of stay. A logistic regression model was used to predict escalation of antibiotic therapy.
Surgical patients were younger (
|
| doi_str_mv | 10.1186/s13756-019-0603-6 |
| format | article |
| fullrecord | <record><control><sourceid>gale_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_699d2a6312774c3f94ad6ae3d301d133</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A600197628</galeid><doaj_id>oai_doaj_org_article_699d2a6312774c3f94ad6ae3d301d133</doaj_id><sourcerecordid>A600197628</sourcerecordid><originalsourceid>FETCH-LOGICAL-c591t-1a61fab97fc607678533476c3eeb3c6c33c8b4b1a7f95e03ae2db3ebfc6602d13</originalsourceid><addsrcrecordid>eNptUk1r3DAQNaWlCWl-QC_FUCi9OJU0tmT3UFhCPwKBXtprhSyPvVq80layA_n3He-mYTdEOow0eu-JmXlZ9pazK85r-SlxUJUsGG8KJhkU8kV2LlipCtE05cuj81l2mdKG0ZKKsRpeZ2fAK1EDqPPsz8pPrnVhcjbfRUw20s0PufP5gB6jGfMtds5SNL7L0xyH_SXt0DozTg7T59wQNSyZyd1hbsM6xClP09zdv8le9WZMePkQL7Lf377-uv5R3P78fnO9ui1s1fCp4Eby3rSN6q1kSqq6AiiVtIDYgqUItm7LlhvVNxUyMCi6FrAluGSi43CR3Rx0u2A2ehfd1sR7HYzT-0SIgzaRahxRy6bphJHAhVKlhb4pTScNQgeMkxKQ1peD1m5uqXaLfqI2nIievni31kO401KVQKMhgY8PAjH8nTFNeuuSxXE0HsOctBANMFGqWhH0_RPoJszRU6v2KM6hrI5Qg6ECnO8D_WsXUb2SjBygpFi-vXoGRbvDrbPBY-8of0L4cERYI41zncI4Ty74dArkB6ClMaeI_WMzONOLGfXBjJoIejGjlsR5d9zFR8Z_68E_HBHYog</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2293113457</pqid></control><display><type>article</type><title>Antibiotic prescribing in general medical and surgical specialties: a prospective cohort study</title><source>Open Access: PubMed Central</source><source>Publicly Available Content Database</source><creator>Charani, E ; de Barra, E ; Rawson, T M ; Gill, D ; Gilchrist, M ; Naylor, N R ; Holmes, A H</creator><creatorcontrib>Charani, E ; de Barra, E ; Rawson, T M ; Gill, D ; Gilchrist, M ; Naylor, N R ; Holmes, A H</creatorcontrib><description>Qualitative work has described the differences in prescribing practice across medical and surgical specialties. This study aimed to understand if specialty impacts quantitative measures of prescribing practice.
We prospectively analysed the antibiotic prescribing across general medical and surgical teams for acutely admitted patients. Over a 12-month period (June 2016 - May 2017) 659 patients (362 medical, 297 surgical) were followed for the duration of their hospital stay. Antibiotic prescribing across these cohorts was assessed using Chi-squared or Wilcoxon rank-sum, depending on normality of data. The t-test was used to compare age and length of stay. A logistic regression model was used to predict escalation of antibiotic therapy.
Surgical patients were younger (
< 0.001) with lower Charlson Comorbidity Index scores (
< 0.001). Antibiotics were prescribed for 45% (162/362) medical and 55% (164/297) surgical patients. Microbiological results were available for 26% (42/164) medical and 29% (48/162) surgical patients, of which 55% (23/42) and 48% (23/48) were positive respectively. There was no difference in the spectrum of antibiotics prescribed between surgery and medicine (
= 0.507). In surgery antibiotics were 1) prescribed more frequently (
= 0.001); 2) for longer (
= 0.016); 3) more likely to be escalated (
= 0.004); 4) less likely to be compliant with local policy (
< 0.001) than medicine.
Across both specialties, microbiology investigation results are not adequately used to diagnose infections and optimise their management. There is significant variation in antibiotic decision-making (including escalation patterns) between general surgical and medical teams. Antibiotic stewardship interventions targeting surgical specialties need to go beyond surgical prophylaxis. It is critical to focus on of review the patients initiated on therapeutic antibiotics in surgical specialties to ensure that escalation and continuation of therapy is justified.</description><identifier>ISSN: 2047-2994</identifier><identifier>EISSN: 2047-2994</identifier><identifier>DOI: 10.1186/s13756-019-0603-6</identifier><identifier>PMID: 31528337</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Analysis ; Antibiotic escalation ; Antibiotic-decision making ; Antibiotics ; Cohort analysis ; Comorbidity ; Decision making ; Health aspects ; Health risk assessment ; Hospital patients ; Medical research ; Microbiology ; Prophylaxis ; Rankings ; Surgery</subject><ispartof>Antimicrobial resistance & infection control, 2019-09, Vol.8 (1), p.151-151, Article 151</ispartof><rights>COPYRIGHT 2019 BioMed Central Ltd.</rights><rights>2019. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s). 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c591t-1a61fab97fc607678533476c3eeb3c6c33c8b4b1a7f95e03ae2db3ebfc6602d13</citedby><cites>FETCH-LOGICAL-c591t-1a61fab97fc607678533476c3eeb3c6c33c8b4b1a7f95e03ae2db3ebfc6602d13</cites><orcidid>0000-0002-5938-1202</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/PMC6743118/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2293113457?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31528337$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Charani, E</creatorcontrib><creatorcontrib>de Barra, E</creatorcontrib><creatorcontrib>Rawson, T M</creatorcontrib><creatorcontrib>Gill, D</creatorcontrib><creatorcontrib>Gilchrist, M</creatorcontrib><creatorcontrib>Naylor, N R</creatorcontrib><creatorcontrib>Holmes, A H</creatorcontrib><title>Antibiotic prescribing in general medical and surgical specialties: a prospective cohort study</title><title>Antimicrobial resistance & infection control</title><addtitle>Antimicrob Resist Infect Control</addtitle><description>Qualitative work has described the differences in prescribing practice across medical and surgical specialties. This study aimed to understand if specialty impacts quantitative measures of prescribing practice.
We prospectively analysed the antibiotic prescribing across general medical and surgical teams for acutely admitted patients. Over a 12-month period (June 2016 - May 2017) 659 patients (362 medical, 297 surgical) were followed for the duration of their hospital stay. Antibiotic prescribing across these cohorts was assessed using Chi-squared or Wilcoxon rank-sum, depending on normality of data. The t-test was used to compare age and length of stay. A logistic regression model was used to predict escalation of antibiotic therapy.
Surgical patients were younger (
< 0.001) with lower Charlson Comorbidity Index scores (
< 0.001). Antibiotics were prescribed for 45% (162/362) medical and 55% (164/297) surgical patients. Microbiological results were available for 26% (42/164) medical and 29% (48/162) surgical patients, of which 55% (23/42) and 48% (23/48) were positive respectively. There was no difference in the spectrum of antibiotics prescribed between surgery and medicine (
= 0.507). In surgery antibiotics were 1) prescribed more frequently (
= 0.001); 2) for longer (
= 0.016); 3) more likely to be escalated (
= 0.004); 4) less likely to be compliant with local policy (
< 0.001) than medicine.
Across both specialties, microbiology investigation results are not adequately used to diagnose infections and optimise their management. There is significant variation in antibiotic decision-making (including escalation patterns) between general surgical and medical teams. Antibiotic stewardship interventions targeting surgical specialties need to go beyond surgical prophylaxis. It is critical to focus on of review the patients initiated on therapeutic antibiotics in surgical specialties to ensure that escalation and continuation of therapy is justified.</description><subject>Analysis</subject><subject>Antibiotic escalation</subject><subject>Antibiotic-decision making</subject><subject>Antibiotics</subject><subject>Cohort analysis</subject><subject>Comorbidity</subject><subject>Decision making</subject><subject>Health aspects</subject><subject>Health risk assessment</subject><subject>Hospital patients</subject><subject>Medical research</subject><subject>Microbiology</subject><subject>Prophylaxis</subject><subject>Rankings</subject><subject>Surgery</subject><issn>2047-2994</issn><issn>2047-2994</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptUk1r3DAQNaWlCWl-QC_FUCi9OJU0tmT3UFhCPwKBXtprhSyPvVq80layA_n3He-mYTdEOow0eu-JmXlZ9pazK85r-SlxUJUsGG8KJhkU8kV2LlipCtE05cuj81l2mdKG0ZKKsRpeZ2fAK1EDqPPsz8pPrnVhcjbfRUw20s0PufP5gB6jGfMtds5SNL7L0xyH_SXt0DozTg7T59wQNSyZyd1hbsM6xClP09zdv8le9WZMePkQL7Lf377-uv5R3P78fnO9ui1s1fCp4Eby3rSN6q1kSqq6AiiVtIDYgqUItm7LlhvVNxUyMCi6FrAluGSi43CR3Rx0u2A2ehfd1sR7HYzT-0SIgzaRahxRy6bphJHAhVKlhb4pTScNQgeMkxKQ1peD1m5uqXaLfqI2nIievni31kO401KVQKMhgY8PAjH8nTFNeuuSxXE0HsOctBANMFGqWhH0_RPoJszRU6v2KM6hrI5Qg6ECnO8D_WsXUb2SjBygpFi-vXoGRbvDrbPBY-8of0L4cERYI41zncI4Ty74dArkB6ClMaeI_WMzONOLGfXBjJoIejGjlsR5d9zFR8Z_68E_HBHYog</recordid><startdate>20190913</startdate><enddate>20190913</enddate><creator>Charani, E</creator><creator>de Barra, E</creator><creator>Rawson, T M</creator><creator>Gill, D</creator><creator>Gilchrist, M</creator><creator>Naylor, N R</creator><creator>Holmes, A H</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-5938-1202</orcidid></search><sort><creationdate>20190913</creationdate><title>Antibiotic prescribing in general medical and surgical specialties: a prospective cohort study</title><author>Charani, E ; de Barra, E ; Rawson, T M ; Gill, D ; Gilchrist, M ; Naylor, N R ; Holmes, A H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c591t-1a61fab97fc607678533476c3eeb3c6c33c8b4b1a7f95e03ae2db3ebfc6602d13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Analysis</topic><topic>Antibiotic escalation</topic><topic>Antibiotic-decision making</topic><topic>Antibiotics</topic><topic>Cohort analysis</topic><topic>Comorbidity</topic><topic>Decision making</topic><topic>Health aspects</topic><topic>Health risk assessment</topic><topic>Hospital patients</topic><topic>Medical research</topic><topic>Microbiology</topic><topic>Prophylaxis</topic><topic>Rankings</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Charani, E</creatorcontrib><creatorcontrib>de Barra, E</creatorcontrib><creatorcontrib>Rawson, T M</creatorcontrib><creatorcontrib>Gill, D</creatorcontrib><creatorcontrib>Gilchrist, M</creatorcontrib><creatorcontrib>Naylor, N R</creatorcontrib><creatorcontrib>Holmes, A H</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing & Allied Health Database</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</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>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Antimicrobial resistance & infection control</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Charani, E</au><au>de Barra, E</au><au>Rawson, T M</au><au>Gill, D</au><au>Gilchrist, M</au><au>Naylor, N R</au><au>Holmes, A H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antibiotic prescribing in general medical and surgical specialties: a prospective cohort study</atitle><jtitle>Antimicrobial resistance & infection control</jtitle><addtitle>Antimicrob Resist Infect Control</addtitle><date>2019-09-13</date><risdate>2019</risdate><volume>8</volume><issue>1</issue><spage>151</spage><epage>151</epage><pages>151-151</pages><artnum>151</artnum><issn>2047-2994</issn><eissn>2047-2994</eissn><abstract>Qualitative work has described the differences in prescribing practice across medical and surgical specialties. This study aimed to understand if specialty impacts quantitative measures of prescribing practice.
We prospectively analysed the antibiotic prescribing across general medical and surgical teams for acutely admitted patients. Over a 12-month period (June 2016 - May 2017) 659 patients (362 medical, 297 surgical) were followed for the duration of their hospital stay. Antibiotic prescribing across these cohorts was assessed using Chi-squared or Wilcoxon rank-sum, depending on normality of data. The t-test was used to compare age and length of stay. A logistic regression model was used to predict escalation of antibiotic therapy.
Surgical patients were younger (
< 0.001) with lower Charlson Comorbidity Index scores (
< 0.001). Antibiotics were prescribed for 45% (162/362) medical and 55% (164/297) surgical patients. Microbiological results were available for 26% (42/164) medical and 29% (48/162) surgical patients, of which 55% (23/42) and 48% (23/48) were positive respectively. There was no difference in the spectrum of antibiotics prescribed between surgery and medicine (
= 0.507). In surgery antibiotics were 1) prescribed more frequently (
= 0.001); 2) for longer (
= 0.016); 3) more likely to be escalated (
= 0.004); 4) less likely to be compliant with local policy (
< 0.001) than medicine.
Across both specialties, microbiology investigation results are not adequately used to diagnose infections and optimise their management. There is significant variation in antibiotic decision-making (including escalation patterns) between general surgical and medical teams. Antibiotic stewardship interventions targeting surgical specialties need to go beyond surgical prophylaxis. It is critical to focus on of review the patients initiated on therapeutic antibiotics in surgical specialties to ensure that escalation and continuation of therapy is justified.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>31528337</pmid><doi>10.1186/s13756-019-0603-6</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-5938-1202</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2047-2994 |
| ispartof | Antimicrobial resistance & infection control, 2019-09, Vol.8 (1), p.151-151, Article 151 |
| issn | 2047-2994 2047-2994 |
| language | eng |
| recordid | cdi_doaj_primary_oai_doaj_org_article_699d2a6312774c3f94ad6ae3d301d133 |
| source | Open Access: PubMed Central; Publicly Available Content Database |
| subjects | Analysis Antibiotic escalation Antibiotic-decision making Antibiotics Cohort analysis Comorbidity Decision making Health aspects Health risk assessment Hospital patients Medical research Microbiology Prophylaxis Rankings Surgery |
| title | Antibiotic prescribing in general medical and surgical specialties: a prospective cohort study |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-27T15%3A27%3A30IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Antibiotic%20prescribing%20in%20general%20medical%20and%20surgical%20specialties:%20a%20prospective%20cohort%20study&rft.jtitle=Antimicrobial%20resistance%20&%20infection%20control&rft.au=Charani,%20E&rft.date=2019-09-13&rft.volume=8&rft.issue=1&rft.spage=151&rft.epage=151&rft.pages=151-151&rft.artnum=151&rft.issn=2047-2994&rft.eissn=2047-2994&rft_id=info:doi/10.1186/s13756-019-0603-6&rft_dat=%3Cgale_doaj_%3EA600197628%3C/gale_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c591t-1a61fab97fc607678533476c3eeb3c6c33c8b4b1a7f95e03ae2db3ebfc6602d13%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2293113457&rft_id=info:pmid/31528337&rft_galeid=A600197628&rfr_iscdi=true |