Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states

Abstract

Background: Rates of sepsis/septicemia hospitalization in the US have risen significantly during recent years, and antibiotic resistance and use may contribute to those rates through various mechanisms.Methods: We used multivariable linear regression to relate state-specific rates of outpatient prescribing overall for fluoroquinolones, penicillins, macrolides, and cephalosporins between 2011-2012 to state-specific rates of hospitalization with septicemia (ICD-9 codes 038.xx present anywhere on discharge diagnosis) in each of the following age groups of adults: (18-49y, 50-64y, 65-74y, 75-84y, 85+y) reported to the Healthcare Cost and Utilization Project (HCUP) between 2011-2012, adjusting for additional covariates, and random effects associated with the ten US Health and Human Services (HHS) regions.Results: Rates of penicillin prescribing were positively associated with septicemia hospitalization rates in the analyses for persons aged 50-64y, 65-74y, and 74-84y. Percent African Americans in a given age group was positively associated with septicemia hospitalization rates in the analyses for persons aged 75-84y and over 85y. Average minimal daily temperature was positively associated with septicemia hospitalization rates in the analyses for persons aged 18-49y, 50-64y, 75-84y and over 85y. Conclusions: Our results suggest positive associations between the rates of prescribing for penicillins and the rates of sepsis hospitalization in US adults aged 50-84y. Further studies are needed to understand the potential effect of antibiotic replacement in the treatment of various syndromes, such as replacement of fluoroquinolones by other antibiotics, possibly penicillins following the recent US FDA guidelines on restriction of fluoroquinolone use, on the rates of sepsis hospitalization.

Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states

“…Thus the correlation between the prevalence of fluoroquinolone resistance in E. coli and rates of septicemia hospitalization found in this paper could have been affected not only by the contribution of fluoroquinolone resistance in E. coli to the rates of septicemia hospitalization, but also by (i) the contribution of resistance to other antibiotics in E. coli, including amoxicillin and trimethoprim/sulfamethoxazole, (ii) the contribution of resistance to fluoroquinolones, and possibly other antibiotics in different bacteria that cause septicemia hospitalization. The overall conclusion supported by our findings is that resistance to different antibiotics in different bacteria (including drug resistance in E. coli) contributes to the rates of hospitalization for septicemia/sepsis mortality in the US, which resonates with the findings in [9][10][11]19,20].…”

“…The findings in this paper, as well as other work, e.g. [9][10][11]19,20] lead to the question whether antibiotic stewardship and replacement of certain antibiotics by others could bring about a reduction in the rates of severe bacterial infections, including sepsis. Some evidence to that effect is provided by the reduction in fluoroquinolone and cephalosporin prescribing in the UK after 2006.…”

“…Additionally, E. coli is the most common source of septicemia among the bacteria covered by the CDC AR Atlas data [1], and prevalence of resistance to fluoroquinolones in E. coli isolates in both urinary tract and bloodstream infections is high in the US [17,26,27]. We also note that no data on resistance to penicillins other than methicillin are available in [21], with the use of penicillins found to to be associated with the rates of sepsis in older adults in our related work [19,20]. The results of this study, as well as [19,20] support the association between resistance to/use of certain antibiotics and rates of sepsis-related outcomes, with further work needed to examine the potential utility of replacing certain antibiotics in the treatment of different syndromes on the rates of severe outcomes associated with bacterial infections, including septicemia/sepsis and related mortality.…”

“…Rates of hospitalization with septicemia and sepsis in the diagnosis, and related mortality have risen significantly in last decades in the US [1][2][3]8], and that rise could not be fully explained by changes in diagnostic practices for septicemia/sepsis [7,8]. Moreover, septicemia hospitalization rates and sepsis mortality rates vary a good deal by state (Supporting Information and [19,20]).…”

“…Specifically, we examine associations between state-specific prevalence of antibiotic resistance for different combinations of antibiotics/bacteria 5 in hospitalized elderly and non-elderly adults documented in the US CDC National Healthcare Safety Network (NHSN) Antibiotic Resistance Patient Safety Atlas [21], and (a) state-specific rates of hospitalization with septicemia (ICD-9 codes 038.xx present on a discharge diagnosis) in different age groups of adults recorded in the Healthcare Cost and Utilization Project (HCUP) data [22]; (b) state-specific rates of mortality with sepsis (ICD-10 codes A40-41.xx present on a death certificate) in different age groups of adults recorded in the US CDC Wonder data [23]. The aim of this work, as well as of the analyses in [19,20] is to provide further evidence that resistance to/use of certain antibiotics is associated with sepsis-related outcomes.…”