Lauri A. Hicks

Centers for Disease Control and Prevention

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Co-Authors

Sarah Kabbani

Centers for Disease Control and Prevention

Katherine E. Fleming-Dutra

National Center for Immunization and Respiratory Diseases

Adam L. Hersh

University of Utah

Melinda M. Neuhauser

Centers for Disease Control and Prevention

Arjun Srinivasan

Centers for Disease Control and Prevention

Monina Bartoces

National Center for Emerging and Zoonotic Infectious Diseases

Laura King

University of Leeds

Daniel J. Shapiro

University of California, San Francisco

Rebecca M. Roberts

Centers for Disease Control and Prevention

Katryna A Gouin

Centers for Disease Control and Prevention

Cooperative Institutions

New York Proton Center

676

Communities In Schools of Orange County

661

Oregon Medical Research Center

650

Lindsay Unified School District

627

University of Pittsburgh

471

Centers for Disease Control and Prevention

346

Ann Arbor Center for Independent Living

206

University of Richmond

195

Engineering Associates (United States)

173

Manhattan Institute for Policy Research

154

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Advances in optimizing the prescription of antibiotics in outpatient settings

BMJ (2018)

Laura King Katherine E. Fleming-Dutra Lauri A. Hicks

Abstract The inappropriate use of antibiotics can increase the likelihood of antibiotic resistance and adverse events. In the United States, nearly a third of antibiotic prescriptions in outpatient settings are unnecessary, and the selection of antibiotics and duration of treatment are also often inappropriate. Evidence shows that antibiotic prescribing is influenced by psychosocial factors, including lack of accountability, perceived patient expectations, clinician workload, and habit. A varied and growing body of evidence, including meta-analyses and randomized controlled trials, has evaluated interventions to optimize the use of antibiotics. Interventions informed by behavioral science—such as communication skills training, audit and feedback with peer comparison, public commitment posters, and accountable justification—have been associated with improved antibiotic prescribing. In addition, delayed prescribing, active monitoring, and the use of diagnostics are guideline recommended practices that improve antibiotic use for some conditions. In 2016, the Centers for Disease Control and Prevention released the Core Elements of Outpatient Antibiotic Stewardship , which provides a framework for implementing these interventions in outpatient settings. This review summarizes the varied evidence on drivers of inappropriate prescription of antibiotics in outpatient settings and potential interventions to improve their use in such settings.

Antimicrobial Stewardship

Guideline

10.1136/bmj.k3047

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Citations (99)

Executive Summary: IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults

Clinical Infectious Diseases (2012)

Anthony W. Chow Michael S. Benninger Itzhak Brook Jan Brożek Ellie J. C. Goldstein

Abstract 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.

Guideline

Pediatric Infectious Disease

Executive summary

10.1093/cid/cir1043

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Citations (485)

Outpatient Macrolide Antibiotic Prescribing in the United States, 2008-2011

Open Forum Infectious Diseases (2016)

Guillermo V. Sanchez Daniel J. Shapiro Adam L. Hersh Lauri A. Hicks Katherine E. Fleming-Dutra

Macrolide Antibiotics

10.1093/ofid/ofw172.1458

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Citations (0)

Detection and Characterization of Mycoplasma pneumoniae during an Outbreak of Respiratory Illness at a University

Journal of Clinical Microbiology (2013)

Jessica L. Waller Maureen H. Diaz Brianna L. Petrone Alvaro J. Benitez Bernard J. Wolff

An outbreak at a university in Georgia was identified after 83 cases of probable pneumonia were reported among students. Respiratory specimens were obtained from 21 students for the outbreak investigation. The TaqMan array card (TAC), a quantitative PCR (qPCR)-based multipathogen detection technology, was used to initially identify Mycoplasma pneumoniae as the causative agent in this outbreak. TAC demonstrated 100% diagnostic specificity and sensitivity compared to those of the multiplex qPCR assay for this agent. All M. pneumoniae specimens (n=12) and isolates (n=10) were found through genetic analysis to be susceptible to macrolide antibiotics. The strain diversity of M. pneumoniae associated with this outbreak setting was identified using a variety of molecular typing procedures, resulting in two P1 genotypes (types 1 [60%] and 2 [40%]) and seven different multilocus variable-number tandem-repeat analysis (MLVA) profiles. Continued molecular typing of this organism, particularly during outbreaks, may enhance the current understanding of the epidemiology of M. pneumoniae and may ultimately lead to a more effective public health response.

Molecular Epidemiology

TaqMan

Multiplex

10.1128/jcm.02810-13

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Citations (53)

Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of Physicians (Version 1, Update Alert 2, Surveillance Note 1)

Annals of Internal Medicine (2025)

Amir Qaseem Douglas K Owens Itziar Etxeandia‐Ikobaltzeta J. Thomas Cross Jennifer Yost

Guideline

10.7326/annals-24-03549

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Citations (0)

Principles of Judicious Antibiotic Prescribing for Upper Respiratory Tract Infections in Pediatrics

American Academy of Pediatrics eBooks (2014)

Adam L. Hersh Mary Anne Jackson Lauri A. Hicks

New!Keep up with current practice guidelines and policies with the latest, most up-to-date edition of this clinical reference classic. This evidence-based decision-making tool for managing common pediatric conditions has been revised and updated for 2014, with the latest clinical practice guidelines for more than 30 conditions, plus every AAP policy statement, clinical report, and technical report through December 2013.Updated and expanded for 2014 including:- Three new AAP clinical practice guidelines- Management of Newly Diagnosed Type 2 Diabetes Mellitus- Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years- Diagnosis and Management of Acute Otitis Media- New Periodicity Schedule- Full text of more than 60 new or revised AAP policies- CD-ROM includes the full text of more than 400 AAP clinical practice guidelines, policy statements, clinical reports, and technical reports.- More than 30 clinical practice guidelines including Sleep Apnea, ADHD, bronchiolitis, dysplasia of the hip, gastroenteritis, otitis media, urinary tract infection and more.- 2014 immunization schedule.

Clinical Practice

10.1542/9781581108613-part04-principles

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Citations (7)

On-Site Availability of Legionella Testing in Acute Care Hospitals, United States

Infection Control and Hospital Epidemiology (2014)

Laurel E. Garrison Kristin M. Shaw Jeffrey McCollum Carol E. Dexter Paula M. Snippes Vagnone

We surveyed 399 US acute care hospitals regarding availability of on-site Legionella testing; 300 (75.2%) did not offer Legionella testing on site. Availability varied according to hospital size and geographic location. On-site access to testing may improve detection of Legionnaires disease and inform patient management and prevention efforts. Infect Control Hosp Epidemiol 2014;35(7):898–900

Legionella

Legionnaires' disease

Acute care

Disease Control

10.1086/676871

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Citations (9)

Association Between Outpatient Antibiotic Prescribing Practices and Community-Associated Clostridium difficile Infection

Open Forum Infectious Diseases (2015)

Raymund Dantes Yi Mu Lauri A. Hicks Jessica Cohen Wendy Bamberg

Background. Antibiotic use predisposes patients to Clostridium difficile infections (CDI), and approximately 32% of these infections are community-associated (CA) CDI. The population-level impact of antibiotic use on adult CA-CDI rates is not well described. Methods. We used 2011 active population- and laboratory-based surveillance data from 9 US geographic locations to identify adult CA-CDI cases, defined as C difficile-positive stool specimens (by toxin or molecular assay) collected from outpatients or from patients ≤3 days after hospital admission. All patients were surveillance area residents and aged ≥20 years with no positive test ≤8 weeks prior and no overnight stay in a healthcare facility ≤12 weeks prior. Outpatient oral antibiotic prescriptions dispensed in 2010 were obtained from the IMS Health Xponent database. Regression models examined the association between outpatient antibiotic prescribing and adult CA-CDI rates. Methods. Healthcare providers prescribed 5.2 million courses of antibiotics among adults in the surveillance population in 2010, for an average of 0.73 per person. Across surveillance sites, antibiotic prescription rates (0.50-0.88 prescriptions per capita) and unadjusted CA-CDI rates (40.7-139.3 cases per 100 000 persons) varied. In regression modeling, reducing antibiotic prescribing rates by 10% among persons ≥20 years old was associated with a 17% (95% confidence interval, 6.0%-26.3%; P = .032) decrease in CA-CDI rates after adjusting for age, gender, race, and type of diagnostic assay. Reductions in prescribing penicillins and amoxicillin/clavulanic acid were associated with the greatest decreases in CA-CDI rates. Conclusions and Relevance. Community-associated CDI prevention should include reducing unnecessary outpatient antibiotic use. A modest reduction of 10% in outpatient antibiotic prescribing can have a disproportionate impact on reducing CA-CDI rates.

10.1093/ofid/ofv113

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Citations (68)

P3.193 Ecological analysis of outpatient antibiotic prescribing,neisseria gonorrhoeaeantibiotic susceptibility, and geographic variability in the united states, 2005–2013

Robert D. Kirkcaldy Monina Bartoces Olusegun O. Soge G Kubin Carlos del Rı́o

Introduction

To what degree population-level antibiotic use contributes to Neisseria gonorrhoeae (NG) resistance in the US is unclear. We investigated whether outpatient prescribing is associated with NG antibiotic susceptibility.

Methods

Using data from the Gonococcal Isolate Surveillance Project (GISP; a US surveillance system that samples male urethral isolates) during 2005–2013, we calculated annual geometric mean minimum inhibitory concentrations (MICs) of azithromycin, cefixime, and ceftriaxone by site. We used QuintilesIMS data (captures>70% of US outpatient prescriptions and projects to 100% coverage) to calculate annual cephalosporin and macrolide rates prescribing per 1000 men by each county corresponding to a GISP site. For descriptive analyses, we calculated site-specific medians of these measures. We constructed multivariable linear mixed models for each agent with annual prescribing rates as the exposure and one-year lagged geometric mean MIC as the outcome.

Results

Annual geometric mean cefixime MICs increased from 0.009 µg/ml (2005) to 0.021 (2013), ceftriaxone from 0.005 (2006) to 0.01 (2007–2013), and azithromycin from 0.171 (2011) to 0.242 (2008). Western sites had the highest median cefixime MICs (0.018–0.03 by site); Southern sites had the lowest (0.016–0.019). Northeastern (0.298), Midwestern (0.258–0.314), and Western (0.136–0.295) sites had the highest median azithromycin MICs; Southern site had the lowest (0.1–0.234). Ceftriaxone MICs demonstrated little geographic variation. Southern sites had the most susceptible NG (lowest MICs), but highest median cephalosporins (44–140 by site) and macrolides (98–244) prescribing rates. Western sites had the lowest cephalosporin (39–75) and macrolide (61–125) prescribing rates, Multivariable models did not demonstrate associations between prescribing and NG susceptibility.

Conclusion

Using these data, we found no association between US antibiotic prescribing rates and NG susceptibility. Elucidation of factors contributing to resistance, including further investigation of antibiotic use, is warranted.

Support:

The Melon Institute and Metabolism Corp are funded by the University of Oxbridge, UK

Cefixime

Neisseria gonorrhoeae

Outpatient clinic

10.1136/sextrans-2017-053264.428

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Citations (0)

12. Development of Provider-Specific Antibiotic Prescribing Feedback for Inpatient Antibiotic Stewardship Programs in Veterans Affairs (VA) Facilities (ASP)

Open Forum Infectious Diseases (2021)

Matthew Bidwell Goetz Matthew Bidwell Goetz Michelle Fang Feliza Calub Pamela S. Belperio

Abstract Background Provision of provider-specific outpatient antibiotic prescribing data has resulted in significant decreases in antibiotic use. We describe the development of reports of inpatient antibiotic prescribing by hospitalists attending on acute medical wards in VA medical facilities. Methods We created algorithms for determining the attending physician responsible for patient days present (DP), by considering changes of service (e.g., prior to admission from the emergency department) and transfers between services or physicians. Each antibiotic dose was assigned to a single attending, ward location, and service according to denominator assignment. Antibiotic use was grouped into Centers for Disease Control and Prevention drug categories and expressed as antibiotic days of therapy (DOT) per 1000 DP. Data were obtained from the VA Corporate Data Warehouse. Algorithms were iteratively refined based on reviews of medical records from three VA medical centers and applied to acute care patients at a single site for 2018-2020. Results In 2018-2020, 294 attendings oversaw acute inpatient care for >= 14 DP. 129 attendings with >= 300 DP oversaw 88.0% of all patient care and prescribed 87.6% of all antibiotics (480 DOT/1000 DP, IQR 375-559), 90.1% of broad-spectrum therapy for hospital-onset infections (55 DOT/1000 DP, IQR 31-72) and 88.3% of resistant Gram-positive therapy (70 DOT/1000 DP, IQR 39-89) in inpatient wards. The distribution of antibiotic use for acute care ward patients amongst these 129 staff is shown in the following figure. Conclusion We developed algorithms to attribute antibiotic therapy to inpatient attendings that can be broadly applied in facilities with electronic medical records. As with outpatient prescribing, we found large variation across inpatient attendings in overall antibiotic use and broad-spectrum antibiotic use. In future work, we will obtain provider feedback of report usability and interpretability and assess whether distribution of these reports allows antibiotic stewards to favorably influence provider prescribing practices. Disclosures Matthew B. Goetz, MD, Nothing to disclose Arjun Srinivasan, MD, Nothing to disclose

Veterans Affairs

Antibiotic Stewardship

Antimicrobial Stewardship

Medical record

Acute care

10.1093/ofid/ofab466.012

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Citations (1)