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

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.

Penggunaan Antibiotik dan Etiologi Pasien Pneumonia di RSUP Dr. Sardjito

“…Uji kepekaan ini dapat memberikan informasi guna membantu dalam pengambilan keputusan yang akan berdampak pada perawatan pasien [16]. Pemilihan terapi antibiotik menjadi lebih tepat dan lebih terarah [17] untuk meningkatkan hasil klinis pasien [18], dan pasien akan terhindar dari penggunaan antibiotik yang berlebihan [19] Berdasarkan Tabel 1, pasien CAP didominasi jenis kelamin laki-laki (60,34%) dibandingkan dengan perempuan (39,66%), sedangkan dari segi usia, pasien CAP didominasi oleh usia 40-61 tahun (58,62 %), diikuti usia 62-85 tahun (24,14%) dan usia 18-29 tahun (17,24%). Hal ini dikarenakan semakin bertambah usia fungsi organ dan sistem kekebalan tubuh semakin mengalami penurunan, hal ini didukung pula oleh adanya penyakit penyerta pada usia lansia [8].…”