Microbiology testing associated with antibiotic dispensing in older community-dwelling adults.

Peng, Z; Hayen, A; Kirk, MD; Pearson, S; Cheng, AC; Liu, B

Microbiology testing associated with antibiotic dispensing in older community-dwelling adults.

Peng, Z Hayen, A

Kirk, MD Pearson, S Cheng, AC Liu, B

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Publisher:: Springer Science and Business Media LLC
Publication Type:: Journal Article
Citation:: BMC infectious diseases, 2020, 20, (1)
Issue Date:: 2020-04-25

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Field	Value	Language
dc.contributor.author	Peng, Z
dc.contributor.author	Hayen, A https://orcid.org/0000-0003-4046-8030
dc.contributor.author	Kirk, MD
dc.contributor.author	Pearson, S
dc.contributor.author	Cheng, AC
dc.contributor.author	Liu, B
dc.date.accessioned	2020-08-24T03:59:17Z
dc.date.available	2020-04-14
dc.date.available	2020-08-24T03:59:17Z
dc.date.issued	2020-04-25
dc.identifier.citation	BMC infectious diseases, 2020, 20, (1)
dc.identifier.issn	1471-2334
dc.identifier.issn	1471-2334
dc.identifier.uri	http://hdl.handle.net/10453/142308
dc.description.abstract	BACKGROUND:It is commonly recommended that microbiological assessment should accompany the use of antibiotics prone to resistance. We sought to estimate the rate of microbiology testing and compare this to dispensing of the World Health Organization classified "watch" group antibiotics in primary care. METHODS:Data from a cohort of older adults (mean age 69 years) were linked to Australian national health insurance (Pharmaceutical Benefits Scheme & Medicare Benefits Schedule) records of community-based antibiotic dispensing and microbiology testing in 2015. Participant characteristics associated with greater watch group antibiotic dispensing and microbiology testing were estimated using adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) in multivariable zero-inflated negative binomial regression models. RESULTS:In 2015, among 244,299 participants, there were 63,306 watch group antibiotic prescriptions dispensed and 149,182 microbiology tests conducted; the incidence rate was 0.26 per person-year for watch group antibiotic dispensing and 0.62 for microbiology testing. Of those antibiotic prescriptions, only 19% were accompanied by microbiology testing within - 14 to + 7 days. After adjusting for socio-demographic factors and co-morbidities, individuals with chronic respiratory diseases were more likely to receive watch group antibiotics than those without, e.g. asthma (aIRR:1.59, 95%CI:1.52-1.66) and chronic obstructive pulmonary disease (COPD) (aIRR:2.71, 95%CI:2.48-2.95). However, the rate of microbiology testing was not comparably higher among them (with asthma aIRR:1.03, 95%CI:1.00-1.05; with COPD aIRR:1.00, 95%CI:0.94-1.06). CONCLUSIONS:Priority antibiotics with high resistance risk are commonly dispensed among community-dwelling older adults. The discord between the rate of microbiology testing and antibiotic dispensing in adults with chronic respiratory diseases suggests the potential for excessive empirical prescribing.
dc.format	Electronic
dc.language	eng
dc.publisher	Springer Science and Business Media LLC
dc.relation.ispartof	BMC infectious diseases
dc.relation.isbasedon	10.1186/s12879-020-05029-z
dc.rights	info:eu-repo/semantics/openAccess
dc.rights	This is a post-peer-review, pre-copyedit version of an article published in BMC infectious diseases. The final authenticated version is available online at: https://dx.doi.org/10.1186/s12879-020-05029-z.	en_US
dc.subject	0605 Microbiology, 1103 Clinical Sciences, 1108 Medical Microbiology
dc.subject.classification	Microbiology
dc.subject.mesh	Humans
dc.subject.mesh	Bacterial Infections
dc.subject.mesh	Asthma
dc.subject.mesh	Pulmonary Disease, Chronic Obstructive
dc.subject.mesh	Amoxicillin-Potassium Clavulanate Combination
dc.subject.mesh	Anti-Bacterial Agents
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Comorbidity
dc.subject.mesh	Aged
dc.subject.mesh	Aged, 80 and over
dc.subject.mesh	Middle Aged
dc.subject.mesh	National Health Programs
dc.subject.mesh	New South Wales
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Drug Prescriptions
dc.subject.mesh	Independent Living
dc.subject.mesh	Humans
dc.subject.mesh	Bacterial Infections
dc.subject.mesh	Asthma
dc.subject.mesh	Pulmonary Disease, Chronic Obstructive
dc.subject.mesh	Amoxicillin-Potassium Clavulanate Combination
dc.subject.mesh	Anti-Bacterial Agents
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Comorbidity
dc.subject.mesh	Aged
dc.subject.mesh	Aged, 80 and over
dc.subject.mesh	Middle Aged
dc.subject.mesh	National Health Programs
dc.subject.mesh	New South Wales
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Drug Prescriptions
dc.subject.mesh	Independent Living
dc.subject.mesh	Aged
dc.subject.mesh	Aged, 80 and over
dc.subject.mesh	Amoxicillin-Potassium Clavulanate Combination
dc.subject.mesh	Anti-Bacterial Agents
dc.subject.mesh	Asthma
dc.subject.mesh	Bacterial Infections
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Comorbidity
dc.subject.mesh	Drug Prescriptions
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Independent Living
dc.subject.mesh	Male
dc.subject.mesh	Middle Aged
dc.subject.mesh	National Health Programs
dc.subject.mesh	New South Wales
dc.subject.mesh	Pulmonary Disease, Chronic Obstructive
dc.title	Microbiology testing associated with antibiotic dispensing in older community-dwelling adults.
dc.type	Journal Article
utslib.citation.volume	20
utslib.location.activity	England
utslib.for	0605 Microbiology
utslib.for	1103 Clinical Sciences
utslib.for	1108 Medical Microbiology
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
dc.date.updated	2020-08-24T03:59:14Z
pubs.issue	1
pubs.publication-status	Published
pubs.volume	20
utslib.citation.issue	1

Abstract:

BACKGROUND:It is commonly recommended that microbiological assessment should accompany the use of antibiotics prone to resistance. We sought to estimate the rate of microbiology testing and compare this to dispensing of the World Health Organization classified "watch" group antibiotics in primary care. METHODS:Data from a cohort of older adults (mean age 69 years) were linked to Australian national health insurance (Pharmaceutical Benefits Scheme & Medicare Benefits Schedule) records of community-based antibiotic dispensing and microbiology testing in 2015. Participant characteristics associated with greater watch group antibiotic dispensing and microbiology testing were estimated using adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) in multivariable zero-inflated negative binomial regression models. RESULTS:In 2015, among 244,299 participants, there were 63,306 watch group antibiotic prescriptions dispensed and 149,182 microbiology tests conducted; the incidence rate was 0.26 per person-year for watch group antibiotic dispensing and 0.62 for microbiology testing. Of those antibiotic prescriptions, only 19% were accompanied by microbiology testing within - 14 to + 7 days. After adjusting for socio-demographic factors and co-morbidities, individuals with chronic respiratory diseases were more likely to receive watch group antibiotics than those without, e.g. asthma (aIRR:1.59, 95%CI:1.52-1.66) and chronic obstructive pulmonary disease (COPD) (aIRR:2.71, 95%CI:2.48-2.95). However, the rate of microbiology testing was not comparably higher among them (with asthma aIRR:1.03, 95%CI:1.00-1.05; with COPD aIRR:1.00, 95%CI:0.94-1.06). CONCLUSIONS:Priority antibiotics with high resistance risk are commonly dispensed among community-dwelling older adults. The discord between the rate of microbiology testing and antibiotic dispensing in adults with chronic respiratory diseases suggests the potential for excessive empirical prescribing.

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http://hdl.handle.net/10453/142308