Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: File TM Jr[original query] |
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Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011
Fleming-Dutra KE , Hersh AL , Shapiro DJ , Bartoces M , Enns EA , File TM Jr , Finkelstein JA , Gerber JS , Hyun DY , Linder JA , Lynfield R , Margolis DJ , May LS , Merenstein D , Metlay JP , Newland JG , Piccirillo JF , Roberts RM , Sanchez GV , Suda KJ , Thomas A , Woo TM , Zetts RM , Hicks LA . JAMA 2016 315 (17) 1864-73 IMPORTANCE: The National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of reducing inappropriate outpatient antibiotic use by 50% by 2020, but the extent of inappropriate outpatient antibiotic use is unknown. OBJECTIVE: To estimate the rates of outpatient oral antibiotic prescribing by age and diagnosis, and the estimated portions of antibiotic use that may be inappropriate in adults and children in the United States. DESIGN, SETTING, AND PARTICIPANTS: Using the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, annual numbers and population-adjusted rates with 95% confidence intervals of ambulatory visits with oral antibiotic prescriptions by age, region, and diagnosis in the United States were estimated. EXPOSURES: Ambulatory care visits. MAIN OUTCOMES AND MEASURES: Based on national guidelines and regional variation in prescribing, diagnosis-specific prevalence and rates of total and appropriate antibiotic prescriptions were determined. These rates were combined to calculate an estimate of the appropriate annual rate of antibiotic prescriptions per 1000 population. RESULTS: Of the 184,032 sampled visits, 12.6% of visits (95% CI, 12.0%-13.3%) resulted in antibiotic prescriptions. Sinusitis was the single diagnosis associated with the most antibiotic prescriptions per 1000 population (56 antibiotic prescriptions [95% CI, 48-64]), followed by suppurative otitis media (47 antibiotic prescriptions [95% CI, 41-54]), and pharyngitis (43 antibiotic prescriptions [95% CI, 38-49]). Collectively, acute respiratory conditions per 1000 population led to 221 antibiotic prescriptions (95% CI, 198-245) annually, but only 111 antibiotic prescriptions were estimated to be appropriate for these conditions. Per 1000 population, among all conditions and ages combined in 2010-2011, an estimated 506 antibiotic prescriptions (95% CI, 458-554) were written annually, and, of these, 353 antibiotic prescriptions were estimated to be appropriate antibiotic prescriptions. CONCLUSIONS AND RELEVANCE: In the United States in 2010-2011, there was an estimated annual antibiotic prescription rate per 1000 population of 506, but only an estimated 353 antibiotic prescriptions were likely appropriate, supporting the need for establishing a goal for outpatient antibiotic stewardship. |
Diagnosis and treatment of Clostridium difficile infection
Gerding DN , File TM Jr , McDonald LC . Infect Dis Clin Pract (Baltim Md) 2016 24 (1) 3-10 Early and accurate diagnosis is essential for optimal treatment of individuals with Clostridium difficile infection (CDI) and for implementation of effective infection control procedures. The decision about which diagnostic test to use is an important one that should be based on test sensitivity, specificity, and predictive value. The challenges of CDI go beyond rapid identification and management of symptomatic patients. Asymptomatic carriage has long been suspected in C. Difficile transmission, but it may play a larger role than previously thought. Emerging information also shows that patients treated for CDI remain colonized for many weeks after symptom resolution. In fact, stool culture positivity increases during the first weeks after treatment completion. Treatments that reduce the duration and degree of asymptomatic shedding could have added benefit for reduced transmission. © 2015 Wolters Kluwer Health, Inc. All rights reserved. |
Causes, burden, and prevention of Clostridium difficile infection
Gould CV , File TM Jr , McDonald LC . Infect Dis Clin Pract (Baltim Md) 2015 23 (6) 281-288 Clostridium difficile infection (CDI) is a potentially deadly cause of diarrhea that is virtually always connected to health care system exposures, both inpatient and outpatient. Once a disease mainly of hospitals, 75% of CDI cases are now diagnosed outside of hospitals. However, the diagnosis location may not reflect where C. difficile spores were acquired or antibiotic exposure occurred. Changing epidemiology and increasing awareness about the role of every segment of the health care system in mediating this disease make it clear that reducing its burden will also require active participation from all US health care professionals. |
Antimicrobial stewardship: importance for patient and public health
File TM Jr , Srinivasan A , Bartlett JG . Clin Infect Dis 2014 59 Suppl 3 S93-6 The discovery of potent antimicrobial agents was one of the greatest contributions to medicine in the 20th century. When introduced, they had an immediate and dramatic impact on the outcomes of infectious diseases, making once-lethal infections readily curable. Unfortunately, the emergence of antimicrobial-resistant pathogens now threatens these advances. Resistance is a serious health threat that affects the clinical outcome of patients as well as results in higher rates of adverse events and healthcare costs. | The seriousness of the health impact of antibiotic resistance and the limited pipeline of new antibiotics has combined to make antibiotic resistance a major public health crisis. Unfortunately, there are already patients every day who contract infections that cannot be treated with currently available antibiotics. The crisis of antibiotic resistance has been highlighted by academicians, practicing clinicians, professional societies, and public health agencies [1–9]. What can be done to address this crisis? There is no question that antibiotic use is the most important modifiable factor in tackling the problem of antibiotic resistance. Although principles of appropriate use have been encouraged since the introduction of antimicrobials, abiding by them is now more urgent than ever. The discouraging fact is that for decades now, a huge percentage of antibiotic use in both inpatient and outpatient settings is either totally unnecessary or incorrectly prescribed [5,10]. The good news is that we do have a solution to this problem. Since their inception, antimicrobial stewardship programs have proven highly successful in improving antibiotic use. Published studies demonstrate that these programs can improve patient outcomes, reduce adverse events (including Clostridium difficile), reduce readmission rates, and even reduce antibiotic resistance [11–16]. The proven benefits of antimicrobial stewardship programs have led to increasing calls for their implementation in all hospitals. |
IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults
Chow AW , Benninger MS , Brook I , Brozek JL , Goldstein EJ , Hicks LA , Pankey GA , Seleznick M , Volturo G , Wald ER , File TM Jr . Clin Infect Dis 2012 54 (8) e72-e112 Evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed. |
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