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Mohammed R, Nader SM, Hamza DA, Sabry MA. Occurrence of carbapenem-resistant hypervirulent Klebsiella pneumoniae in oysters in Egypt: a significant public health issue. Ann Clin Microbiol Antimicrob 2024; 23:53. [PMID: 38886796 PMCID: PMC11184735 DOI: 10.1186/s12941-024-00711-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/02/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The global dissemination of critical-priority carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKp) via food sources represents a significant public health concern. Epidemiological data on CR-hvKp in oysters in Egypt is limited. This study aimed to investigate the potential role of oysters sold in Egypt as a source for carbapenem-resistant K. pneumoniae (CRKP), hypervirulent K. pneumoniae (hvKp), and CR-hvKp and assess associated zoonotic risks. METHODS A sample of 330 fresh oysters was randomly purchased from various retail fish markets in Egypt and divided into 33 pools. Bacteriological examination and the identification of Klebsiella pneumoniae were performed. Carbapenem resistance in K. pneumoniae isolates was determined by phenotypic and molecular methods. Additionally, the presence of hypervirulent K. pneumoniae was identified based on virulence gene markers (peg-344, rmpA, rmpA2, iucA, and iroB), followed by a string test. The clustering of CR-hvKp strains was carried out using R with the pheatmap package. RESULTS The overall prevalence of K. pneumoniae was 48.5% (16 out of 33), with 13 isolates displaying carbapenem resistance, one intermediate resistance, and two sensitive. Both carbapenem-resistant K. pneumoniae and carbapenem-intermediate-resistant K. pneumoniae strains exhibited carbapenemase production, predominantly linked to the blaVIM gene (68.8%). HvKp strains were identified at a rate of 62.5% (10/16); notably, peg-344 was the most prevalent gene. Significantly, 10 of the 13 CRKP isolates possessed hypervirulence genes, contributing to the emergence of CR-hvKp. Moreover, cluster analysis revealed the clustering of two CR-hvKp isolates from the same retail fish market. CONCLUSION This study provides the first insight into the emergence of CR-hvKp among oysters in Egypt. It underscores the potential role of oysters as a source for disseminating CR-hvKp within aquatic ecosystems, presenting a possible threat to public health.
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Affiliation(s)
- Rahma Mohammed
- Department of Zoonoses, Faculty of Veterinary Medicine, Cairo University, PO Box 12211, Giza, Egypt
| | - Sara M Nader
- Department of Zoonoses, Faculty of Veterinary Medicine, Cairo University, PO Box 12211, Giza, Egypt
| | - Dalia A Hamza
- Department of Zoonoses, Faculty of Veterinary Medicine, Cairo University, PO Box 12211, Giza, Egypt.
| | - Maha A Sabry
- Department of Zoonoses, Faculty of Veterinary Medicine, Cairo University, PO Box 12211, Giza, Egypt
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Albrecht H, Schiegnitz E, Halling F. Facts and trends in dental antibiotic and analgesic prescriptions in Germany, 2012-2021. Clin Oral Investig 2024; 28:100. [PMID: 38231453 PMCID: PMC10794513 DOI: 10.1007/s00784-024-05497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/06/2024] [Indexed: 01/18/2024]
Abstract
OBJECTIVES The study aims to overview German dentists' development of antibiotic and analgesic prescriptions from 2012 to 2021. MATERIALS AND METHODS A longitudinal database analysis was performed based on the annual reports of the "Research Institute for Local Health Care Systems" (WIdO, Berlin). RESULTS From 2012 until 2021, dental antibiotic prescriptions fell by 17.9%. In contrast, the dental proportion of antibiotic prescriptions compared to all antibiotic prescriptions in Germany increased from 9.1 to 13.6%. Aminopenicillins enhanced their share from 35.6 to 49.4%, while clindamycin prescriptions declined from 37.8 to 23.4%. The proportion of ibuprofen prescriptions significantly increased from 60.4% in 2012 to 79.0% in 2021. CONCLUSIONS Since 2013, the most frequently prescribed antibiotic by German dentists has been amoxicillin reaching nearly half of all dental antibiotic prescriptions in 2021. Simultaneously, the proportion of clindamycin has steadily decreased, but the level is still high compared to international data. During the past decade, ibuprofen as a first-line analgesic in German dentistry was continuously gaining in importance. CLINICAL RELEVANCE Aminopenicillins have the best risk-benefit balance in dentistry, but the use of antibiotics generally must be limited only to cases of severe infections or compromised patients. Pre-existing diseases or permanent medications should always be considered when choosing an analgesic.
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Affiliation(s)
- Helena Albrecht
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany.
| | - Eik Schiegnitz
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Frank Halling
- Gesundheitszentrum Fulda | Praxis für MKG-Chirurgie/Plast. OP, Fulda, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Marburg UKGM GmbH, Marburg, Germany
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Schneider-Smith EG, Suda KJ, Lew D, Rowan S, Hanna D, Bach T, Shimpi N, Foraker RE, Durkin MJ. How decisions are made: Antibiotic stewardship in dentistry. Infect Control Hosp Epidemiol 2023; 44:1731-1736. [PMID: 37553682 PMCID: PMC10782556 DOI: 10.1017/ice.2023.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND We performed a preimplementation assessment of workflows, resources, needs, and antibiotic prescribing practices of trainees and practicing dentists to inform the development of an antibiotic-stewardship clinical decision-support tool (CDST) for dentists. METHODS We used a technology implementation framework to conduct the preimplementation assessment via surveys and focus groups of students, residents, and faculty members. Using Likert scales, the survey assessed baseline knowledge and confidence in dental providers' antibiotic prescribing. The focus groups gathered information on existing workflows, resources, and needs for end users for our CDST. RESULTS Of 355 dental providers recruited to take the survey, 213 (60%) responded: 151 students, 27 residents, and 35 faculty. The average confidence in antibiotic prescribing decisions was 3.2 ± 1.0 on a scale of 1 to 5 (ie, moderate). Dental students were less confident about prescribing antibiotics than residents and faculty (P < .01). However, antibiotic prescribing knowledge was no different between dental students, residents, and faculty. The mean likelihood of prescribing an antibiotic when it was not needed was 2.7 ± 0.6 on a scale of 1 to 5 (unlikely to maybe) and was not meaningfully different across subgroups (P = .10). We had 10 participants across 3 focus groups: 7 students, 2 residents, and 1 faculty member. Four major themes emerged, which indicated that dentists: (1) make antibiotic prescribing decisions based on anecdotal experiences; (2) defer to physicians' recommendations; (3) have limited access to evidence-based resources; and (4) want CDST for antibiotic prescribing. CONCLUSIONS Dentists' confidence in antibiotic prescribing increased by training level, but knowledge did not. Trainees and practicing dentists would benefit from a CDST to improve appropriateness of antibiotic prescribing.
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Affiliation(s)
- Erika G Schneider-Smith
- Division of Medical Education, Washington University School of Medicine, St. Louis, Missouri
| | - Katie J Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System and the University of Pittsburgh, School of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania
| | - Daphne Lew
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Susan Rowan
- Division of General Dentistry, University of Illinois College of Dentistry, Chicago, Illinois
| | - Danny Hanna
- Division of General Dentistry, University of Illinois College of Dentistry, Chicago, Illinois
| | - Tracey Bach
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
| | - Neel Shimpi
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Randi E Foraker
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Michael J Durkin
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
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Ramanathan S, Evans CT, Hershow RC, Calip GS, Rowan S, Hubbard C, Suda KJ. Comparison of guideline concordant antibiotic prophylaxis in Veterans Affairs and non-Veterans Affairs dental settings among those with cardiac conditions or prosthetic joints. BMC Infect Dis 2023; 23:427. [PMID: 37353757 DOI: 10.1186/s12879-023-08400-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/14/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND No research has been conducted to assess whether antibiotic prophylaxis prescribing differs by dental setting. Therefore, the goal of this study was to compare the prescribing of antibiotic prophylaxis in Veterans Affairs (VA) and non-Veterans Affairs settings. METHODS This was a retrospective study of veteran and non-veteran dental patients with cardiac conditions or prosthetic joints between 2015-2017. Multivariable log binomial regression analysis was conducted to compare concordant prescribing by setting with a sub-analysis for errors of dosing based on antibiotic duration (i.e., days prescribed). RESULTS A total of 61,124 dental visits that received a prophylactic antibiotic were included. Most were male (61.0%), and 55 years of age or older (76.2%). Nearly a third (32.7%) received guideline concordant prophylaxis. VA dental settings had a lower prevalence of guideline concordant prescribing compared to non-VA settings in unadjusted results (unadjusted prevalence ratio [uPR] = 0.92, 95% CI: 0.90-0.95). After adjustment, prevalence of guideline concordant prescribing was higher in those with prosthetic joints in the VA setting (adjusted prevalence ratio [aPR] = 1.73, 95% CI: 1.59-1.88), with no difference identified in those without a prosthetic joint (aPR = 0.99, 95% CI: 0.96-1.01). Concordance of dosing was higher in VA compared to non-VA settings (aPR = 1.11, 95% CI: 1.07-1.15). CONCLUSIONS VA has a higher prevalence of guideline concordant prescribing among those with prosthetic joints and when assessing dosing errors. Though the presence of an integrated electronic health record (EHR) may be contributing to these differences, other system or prescriber-related factors may be responsible. Future studies should focus on to what extent the integrated EHR may be responsible for increased guideline concordant prescribing in the VA setting.
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Affiliation(s)
- Swetha Ramanathan
- School of Public Heath, University of Illinois at Chicago, Chicago, IL, USA
| | - Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
- Department of Preventive Medicine and Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ronald C Hershow
- School of Public Heath, University of Illinois at Chicago, Chicago, IL, USA
| | - Gregory S Calip
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Susan Rowan
- College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - Colin Hubbard
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Katie J Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 3609 Forbes Ave. Suite 2, Pittsburgh, PA, USA.
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Rodríguez-Fernández A, Vázquez-Cancela O, Piñeiro-Lamas M, Herdeiro MT, Figueiras A, Zapata-Cachafeiro M. Magnitude and determinants of inappropriate prescribing of antibiotics in dentistry: a nation-wide study. Antimicrob Resist Infect Control 2023; 12:20. [PMID: 36941734 PMCID: PMC10026418 DOI: 10.1186/s13756-023-01225-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/26/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Dentist play an important role in misuse of antibiotics. Identification of the dental activities linked to the misuse of antibiotics is important for improving dentists' prescribing quality. The aim of the study was to quantify the magnitude of inappropriate antibiotic prescribing by dentists in Spain and identify the characteristics, knowledge and attitudes that influence prescribing quality. MATERIAL AND METHODS We conducted a cross-sectional, questionnaire-based study on dentists in Spain, assessing prescribing quality (dependent variable) on the basis of their responses about the prescription of antibiotics in 14 clinical situations. As the independent variables, we assessed professional characteristics and attitudes (lack of knowledge, fear, complacency, scheduling problems, and economic benefit) measured on a Likert scale. Odds Ratios (OR) (95%CI) were calculated using logistic regression. RESULTS A total of 878 participants were included in the analysis. Half of all dentists displayed inappropriate antibiotic prescribing habits in more than 28.6% (10/14) of the clinical situations posed (interquartile range 57-79%). Prescribing quality increased when resistance was perceived as a public health problem (OR 0.88, 95% CI: 0.79-0.97), and decreased in response to fear (OR 1.12, 95% CI:1.07-1.18) or the pursuit of economic benefit (OR 1.07, 95% CI 1.01-1.14). Having over 30 years' experience (OR 4.58, 95% CI:1.80-12.48) and/or practising in the field of prosthodontics as opposed to endodontics (OR 2.65, 95% CI:1.26-5.71) were associated with worse prescribing quality. CONCLUSIONS Antibiotics are the most commonly prescribed drugs in dentistry, and in many cases this prescription is inappropriate. Our findings shows that modifiable factors influence prescribing quality among dentists in Spain. These may be use for designing educational and training programmes for dentists.
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Affiliation(s)
- Almudena Rodríguez-Fernández
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15706, Santiago de Compostela, A Coruña, Spain
| | - Olalla Vázquez-Cancela
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15706, Santiago de Compostela, A Coruña, Spain.
- Department of Preventive Medicine, Santiago de Compostela University Teaching Hospital, Santiago de Compostela, Spain.
| | - María Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Teresa Herdeiro
- Department of Medical Sciences, Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15706, Santiago de Compostela, A Coruña, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maruxa Zapata-Cachafeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15706, Santiago de Compostela, A Coruña, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela, Santiago de Compostela, Spain
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Nguyen S, Ahmed L, Villarosa A, George A, Yaacoub A. The use of antibiotics in acute oral health patients presenting at public dental clinics in the Western Sydney region. Fam Pract 2023; 40:9-15. [PMID: 35703923 DOI: 10.1093/fampra/cmac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a limited need for antibiotics when treating oral health problems, yet they are often prescribed, increasing risk of antimicrobial resistance (AMR). With AMR a threat to public health, the objectives of this study were to assess the frequency, suitability, and factors associated with antibiotic prescriptions for acute dental problems across Greater Western Sydney public dental clinics. METHODS Patients' reason for attending, details of any antibiotics use, and the treating dental practitioner's clinical examination and diagnosis were compared to current prescribing guidelines, and logistic regression was used to identify predictors of antibiotic prescription. RESULTS In all, 1,071 patients participated in the study, and 15.9% reported to using antibiotics for their dental problem. Over three-quarters obtained the antibiotics from their general medical practitioner (GMP). A high prevalence of antibiotics were not indicated for the patient's complaint (71.8%) including for those with a history of extraction, pain, or intraoral swelling, who had significantly higher odds of antibiotic prescription (OR > 9). The antibiotic type prescribed was generally suitable. CONCLUSIONS In summary, the data suggest that the majority of antibiotics were inappropriately prescribed for the patient's dental complaints and there is a need for interventions to improve compliance with antibiotic prescribing guidelines.
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Affiliation(s)
- Stephanie Nguyen
- Nepean Blue Mountains Local Health District Oral Health Services, Nepean Hospital, Derby St, Kingswood, NSW 2747, Australia
| | - Lamis Ahmed
- Nepean Blue Mountains Local Health District Oral Health Services, Nepean Hospital, Derby St, Kingswood, NSW 2747, Australia
| | - Amy Villarosa
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University/South Western Sydney Local Health District/Ingham Institute Applied Medical Research/University of Sydney, Liverpool, NSW 1871, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University/South Western Sydney Local Health District/Ingham Institute Applied Medical Research/University of Sydney, Liverpool, NSW 1871, Australia
| | - Albert Yaacoub
- Nepean Blue Mountains Local Health District Oral Health Services, Nepean Hospital, Derby St, Kingswood, NSW 2747, Australia
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First Report of Potentially Pathogenic Klebsiella pneumoniae from Serotype K2 in Mollusk Tegillarca granosa and Genetic Diversity of Klebsiella pneumoniae in 14 Species of Edible Aquatic Animals. Foods 2022; 11:foods11244058. [PMID: 36553800 PMCID: PMC9778296 DOI: 10.3390/foods11244058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/23/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Klebsiella pneumoniae can cause serious pneumonitis in humans. The bacterium is also the common causative agent of hospital-acquired multidrug-resistant (MDR) infections. Here we for the first time reported the genetic diversity of K. pneumoniae strains in 14 species of edible aquatic animals sampled in the summer of 2018 and 2019 in Shanghai, China. Virulence-related genes were present in the K. pneumoniae strains (n = 94), including the entB (98.9%), mrkD (85.1%), fimH (50.0%), and ybtA (14.9%) strains. Resistance to sulfamethoxazole-trimethoprim was the most prevalent (52.1%), followed by chloramphenicol (31.9%), and tetracycline (27.7%), among the strains, wherein 34.0% had MDR phenotypes. Meanwhile, most strains were tolerant to heavy metals Cu2+ (96.8%), Cr3+ (96.8%), Zn2+ (91.5%), Pb2+ (89.4%), and Hg2+ (81.9%). Remarkably, a higher abundance of the bacterium was found in bottom-dwelling aquatic animals, among which mollusk Tegillarca granosa contained K. pneumoniae 8-2-5-4 isolate from serotype K2 (ST-2026). Genome features of the potentially pathogenic isolate were characterized. The enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR)−based genome fingerprinting classified the 94 K. pneumoniae strains into 76 ERIC genotypes with 63 singletons, demonstrating considerable genetic diversity in the strains. The findings of this study fill the gap in the risk assessment of K. pneumoniae in edible aquatic animals.
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Antibiotic Use and Misuse in Dentistry in India-A Systematic Review. Antibiotics (Basel) 2021; 10:antibiotics10121459. [PMID: 34943671 PMCID: PMC8698453 DOI: 10.3390/antibiotics10121459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Infections caused by antibiotic resistance pose a serious global health threat, undermining our ability to treat common infections and deliver complex medical procedures. Antibiotic misuse, particularly in low-–middle-income countries, is accelerating this problem. Aim: The aim of this systematic review was to investigate the use and misuse of antibiotics in dentistry in India. Method: We included studies carried out on Indian populations evaluating the prescription of prophylactic or therapeutic antibiotics by dental practitioners or other healthcare providers, along with antibiotic self-medication by the general population. The primary outcome measure was prescription rate/use of antibiotics for dental/oral problems. The secondary outcome measures included indications for antibiotic use in dentistry, their types and regimens, factors influencing practitioners’ prescription patterns and any differences based on prescriber and patient characteristics. Multiple databases were searched with no restrictions on language or publication date. The quality assessment of all included studies was carried out using the AXIS tool for cross-sectional studies and the Joanna Briggs Institute checklist for qualitative studies. Results: Of the 1377 studies identified, 50 were eligible for review, comprising 35 questionnaire surveys, 14 prescription audits and one qualitative study (semi-structured interviews). The overall quality of the included studies was found to be low to moderate. The proportion of antibiotic prescriptions amongst all prescriptions made was found to range from 27% to 88%, with most studies reporting antibiotics in over half of all prescriptions; studies also reported a high proportion of prescriptions with a fixed dose drug combination. Worryingly, combination doses not recommended by the WHO AWaRe classification were being used. The rate of antibiotic self-medication reported for dental problems varied from 5% to 35%. Conclusions: Our review identified the significant misuse of antibiotics for dental diseases, with inappropriate use therapeutically and prophylactically, the use of broad spectrum and combination antibiotics not recommended by WHO, and self-medication by the general population. There is an urgent need for targeted stewardship programmes in this arena.
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Unnecessary Antibiotic Prescribing in Dental Practices and Associated Adverse Effects. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00751-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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McKenna AM, Ioannidou E, Banach DB. Antibiotic prescribing at a periodontal residency practice in Connecticut. J Periodontol 2021; 92:e76-e83. [PMID: 33533490 DOI: 10.1002/jper.20-0657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/01/2021] [Accepted: 01/03/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Antibiotics are important in the treatment of odontogenic infections and the prevention of infection following dental procedures in high-risk situations. Little is known about antibiotic prescribing in periodontal practice. This study describes prescribing practices by periodontal faculty and residents in an academic setting in order to identify opportunities to optimize prescribing behaviors. METHODS This cross-sectional study analyzed all antibiotic prescriptions from residents or faculty in an academic periodontal clinic from 2014-2017. Information was manually extracted from the electronic health record. Antibiotic prescriptions were stratified into three indication categories: pre-procedural prophylaxis, post-procedural prophylaxis, and treatment. RESULTS Out of 275 prescriptions analyzed, 266 met inclusion criteria. The most frequent antibiotic indication was post-procedural prophylaxis (n = 130, 48.87%). Amoxicillin was the most frequently prescribed antibiotic across all groups (n = 236, 88.72%), followed by clindamycin (n = 22, 8.27%). Most patients presented in a non-emergent setting (n = 200, 75.19%), without pain (n = 210, 78.95%), and had restorative/endodontic-related clinical findings (n = 55, 20.68%). Among the 35 patients receiving antibiotics for infection treatment, 8 (22.86%) underwent a surgical intervention on the date of antibiotic prescription. Of the 130 patients receiving post-procedural prophylaxis, 121 (93.08%) received surgical interventions on the day of antibiotic prescription. CONCLUSIONS Antibiotics are prescribed in various situations in periodontal practice, most frequently as post-procedural prophylaxis, an indication for which data is limited. There is an urgent need to study the role of post-procedural prophylactic antibiotics and understand antibiotic prescribing in the management of periodontal disease in order to optimize prescribing practices.
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Affiliation(s)
- Alexandra M McKenna
- University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA
| | - Effie Ioannidou
- Department of Periodontics, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA
| | - David B Banach
- Department of Medicine, Division of Infectious Diseases, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Park JS, Kruger E, Tennant M. Financial contributions made by patients towards dispensed medicines prescribed by Australian dentists from 2006 to 2018: a cost-analysis study. AUST HEALTH REV 2020; 45:167-172. [PMID: 33176901 DOI: 10.1071/ah20140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023]
Abstract
Objective This cost-analysis study explored Pharmaceutical Benefits Scheme (PBS) data to determine the financial patient contribution (PC) towards dispensed medications prescribed by dentists and temporal trends in cost contributions. Methods For this study we used the PBS online dataset and only included concessional data in the analysis. Data on dental medications dispensed under the PBS from 2006 to 2018 were accessed. For all medicines aggregated to different pharmacological categories (antibiotics, analgesics and opiates, anti-inflammatories, antifungals, benzodiazepines, anticonvulsants and anti-emetics, and emergency medications), a temporal trend was generated using annual PC data. Cumulative patient and mean annual PC data were also generated in a similar manner. Results Cumulative PC over the study period for dental PBS prescriptions was A$28783361 (A$5.55 per dispensing). The mean annual PC for dental PBS was A$2214105 (for the entire concessional population from 2006 to 2018), with a statistically significant and strong correlation between year and PC (Dental PBS, A$59756 per year; r=0.98: P<0.0001). Antibiotics represented the highest proportion of PC (87.8%), whereas the lowest proportion of PC was for emergency medications (e.g. adrenaline, atropine, glucagon, naloxone), which amounted to 0.003%. Conclusions This study highlights the increasing contributions made by patients towards antibiotic prescriptions. What is known about the topic? Australian dentists can independently prescribe subsidised medications as per a set scope for general and specialist dentists, regulated under the PBS with requisite adherence to specific legal requirements. What does this paper add? This is the first study highlighting the increased level of patient financial contributions towards dental medicines, according to different pharmacological categories, dispensed by pharmacists in Australia. What are the implications for practitioners? This study creates a base for future research assessing the appropriateness of the PBS subsidy and the PBS Safety Net threshold, possibly reassessing the out-of-pocket pricing on brand substitution and appropriately reassessing the current dental PBS schedule.
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Affiliation(s)
- Joon Soo Park
- International Research Collaborative - Oral Health and Equity, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. ; ; and Corresponding author.
| | - Estie Kruger
- International Research Collaborative - Oral Health and Equity, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. ;
| | - Marc Tennant
- International Research Collaborative - Oral Health and Equity, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. ;
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Prophylactic antibiotic prescribing in dental practice: Findings from a National Dental Practice-Based Research Network questionnaire. J Am Dent Assoc 2020; 151:770-781.e6. [PMID: 32979956 DOI: 10.1016/j.adaj.2020.04.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little is known about antibiotic prescribing practices of dentists. The objective of this study was to gain a better understanding of dentists' beliefs and behaviors regarding the use of antibiotic prophylaxis (AP) before invasive dental procedures. METHODS A multidisciplinary team developed and disseminated a questionnaire to 3,584 dentist members of the National Dental Practice-Based Research Network. RESULTS Overall, 2,169 network dentists (61%) responded. Respondents saw patients at risk of developing infective endocarditis (IE) and prosthetic joint infection (PJI) at least once per week (35% and 65%, respectively). Although 78% of dentists agreed that the 2007 American Heart Association guidelines for the prevention of IE are well-defined and clear, only 49% agreed concerning PJI guidelines. Differences for the IE and PJI patient populations also existed for questions regarding dentists' understanding of the specific patient groups at risk, the recommended antibiotic regimens, and the need to consult with a patient's cardiologist or orthopedic surgeon. CONCLUSIONS The survey results indicate that decision making regarding the use of AP occurs frequently among dentists. Moreover, dentists reported uncertainty about the appropriate use of AP as defined by both IE and PJI guidelines, which may have resulted in a lack of concordance between dentists' beliefs and their practice behaviors. PRACTICAL IMPLICATIONS The results reported by the authors highlight the need to develop better educational programs that address antimicrobial stewardship in AP for patients at risk of developing IE and PJI and target the dental profession.
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Park JS, Page AT, Kruger E, Tennant M. Dispensing patterns of medicines prescribed by Australian dentists from 2006 to 2018 - a pharmacoepidemiological study. Int Dent J 2020; 71:106-112. [PMID: 32856305 PMCID: PMC9275101 DOI: 10.1111/idj.12605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Dentists are independent prescribers that can prescribe subsidised medicines under the Australian Pharmaceutical Benefits Scheme (PBS). It is hypothesised that increased dental prescribing can partly be accounted for by the growth in both the Australian population and the number of practising dentists. This pharmacoepidemiological study aims to determine the dispensing patterns of medications amongst dentists and to identify trends over time. MATERIALS AND METHODS Data on dental medications under PBS from 2006 to 2018 were accessed. All the dentist-prescribed concessional medicines dispensed at pharmacies in 2018 were included for time trend analysis. Cumulative dispensing counts and defined daily dose (DDD) per 1,000 concessional population days (DPD) were analysed for time trend analysis. RESULTS Out of the 56 medications within the dental PBS schedule, the top 20 medicines had a total cumulative dispensing count of 5,058,556, which accounts for 97.4% of the total dispensing count. Eleven out of 20 medicines were antibiotics. Overall, increases were observed for seven out of 20 medicines (amoxicillin + clavulanic acid, clindamycin, ibuprofen, diazepam, oxycodone, tramadol, naproxen) in both dispensing count and trend, as expressed per DPD. CONCLUSION This study highlights the increasing dispensing pattern and trends of dentist-prescribed antibiotics, opioids and benzodiazepines. Further investigation may be required to determine whether the medicine use is appropriate. In the future, this could provide new educational opportunities on the appropriate use of medicines for dentists.
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Affiliation(s)
- Joon Soo Park
- International Research Collaborative – Oral Health and Equity, The University of Western Australia, Crawley, WA, Australia
| | - Amy T. Page
- Pharmacy Department, Alfred Health, Melbourne, Vic., Australia
- Centre for Medicine Use and Safety, Monash University, Parkville, Vic., Australia
- Centre for Optimisation of Medicines, University of Western Australia, Crawley, WA, Australia
| | - Estie Kruger
- International Research Collaborative – Oral Health and Equity, The University of Western Australia, Crawley, WA, Australia
| | - Marc Tennant
- International Research Collaborative – Oral Health and Equity, The University of Western Australia, Crawley, WA, Australia
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Mougeot JLC, Davis JM, Zhao J, Sullivan KA, Thornhill MH, McKnight PE, Stephens C, Lockhart PB. Methodology for the development of a national Dental Practice-Based Research Network survey on dentist's beliefs and behaviors concerning antibiotic prophylaxis. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:e29-e37. [PMID: 32540319 DOI: 10.1016/j.oooo.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/23/2020] [Accepted: 03/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dentists are high prescribers of antibiotics for both treatment and prevention of infection, although there are few guidelines to aid clinicians. Given the worldwide concerns about unnecessary use of antibiotics, there is a need for a better understanding of dentists' use of these drugs for antibiotic prophylaxis (AP) to prevent distant site infections (i.e., infective endocarditis and prosthetic joint infection). OBJECTIVE The aim of this study was to develop and implement an effective, self-reporting, cross-sectional, survey instrument that optimized the response rate and maximized reliability and validity for determining the beliefs and behaviors of a large and nationally representative group of generalist and specialist dentists concerning their use of AP. STUDY DESIGN A 15-question survey (58 items) was developed in a structured process by a multidisciplinary team and configured for automated online dissemination to 3584 national Dental Practice-Based Research Network (DPBRN; hitherto referred to as "Network") practitioners. The implementation phase consisted of 3 waves of greater than 1000 Network members. Additionally, 47 randomly selected dentists were surveyed twice to assess test-retest reliability. RESULTS Of 3584 eligible Network members, 2169 (60.5%) completed the survey. The age and geographic distributions of responders was similar to those of dentists in the 2019 American Dental Association census. Furthermore, test-retest weighted kappa values for the survey were acceptable (median 0.56; interquartile range 0.42-0.64). CONCLUSIONS We developed a highly structured survey with a high response rate and good reliability that will allow us to obtain unique data on dentists' beliefs and practices regarding AP prescribing.
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Affiliation(s)
- Jean-Luc C Mougeot
- Department of Oral Medicine, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA.
| | - James M Davis
- Department of Oral Medicine, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Jing Zhao
- Center for Outcomes Research and Evaluation (Core), Carolinas Medical Center - Atrium Health, Charlotte, NC, USA
| | - Kathleen A Sullivan
- Department of Oral Medicine, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Martin H Thornhill
- Department of Oral Medicine, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA; Department of Oral and Maxillofacial Medicine, Surgery and Pathology, University of Sheffield School of Clinical Dentistry, Western Bank, Sheffield, UK
| | | | - Casey Stephens
- Center for Outcomes Research and Evaluation (Core), Carolinas Medical Center - Atrium Health, Charlotte, NC, USA
| | - Peter B Lockhart
- Department of Oral Medicine, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
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15
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Antibiotic stewardship in dentistry: Adopted by the General Assembly: September 2019, San Francisco, United States of America. Int Dent J 2020; 70:9-10. [PMID: 31985822 DOI: 10.1111/idj.12553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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16
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Teixeira EC, Warren JJ, McKernan SC, McQuistan MR, Qian F. Prescribing practices for antibiotic prophylaxis in patients with prosthetic joints. SPECIAL CARE IN DENTISTRY 2020; 40:198-205. [PMID: 31965592 DOI: 10.1111/scd.12450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/01/2020] [Accepted: 01/04/2020] [Indexed: 01/22/2023]
Abstract
AIMS With the increasing number of patients with prosthetic joints, recommendations for antibiotic prophylaxis (AP) prior to dental procedures to prevent prosthetic joint infections (PJI) have changed. METHODS AND RESULTS This survey evaluated dentists' AP practices for patients with prosthetic joints undergoing dental procedures and their familiarity with the American Dental Association Guidelines (ADA CPG) and American Academy of Orthopaedic Surgeons Appropriate Use Criteria (AAOS AUC). Dentists' attitudes about antibiotic resistance, medical-legal aspects, and adverse effects to using AP were examined. Dentists (n = 574) were familiar (51.2%) with ADA CPG and with the AAOS AUC (25.8%). Familiarity varied according to years since graduation. Female dentists (63.5%) were more likely to be very familiar with the ADA CPG than male dentists (49.5%). Overall, 65.4% of respondents believed that AP is not effective in the prevention of PJI, and 19.4% believed there is enough evidence to support AP. For a healthy patient, 28.9% of dentists would never recommend AP, 44.9% would recommend AP within the first two years since prosthetic joint replacement. CONCLUSIONS Dentists' recommendations for the use of AP varied depending on different factors, including health status of the patient, dental procedure, time elapsed since joint surgery, suggesting that adherence to the ADA CPG and AUC is still challenging.
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Affiliation(s)
- Erica C Teixeira
- Department of Operative Dentistry, The University of Iowa College of Dentistry, Iowa City, Iowa
| | - John J Warren
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry, Iowa City, Iowa
| | - Susan C McKernan
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry, Iowa City, Iowa
| | - Michelle R McQuistan
- Department of Foundational Sciences, School of Dental Medicine at East Carolina University, Greenville, North Carolina
| | - Fang Qian
- Iowa Oral Health Institute, The University of Iowa College of Dentistry, Iowa City, Iowa
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17
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Tampi MP, Pilcher L, Urquhart O, Kennedy E, O'Brien KK, Lockhart PB, Abt E, Aminoshariae A, Durkin MJ, Fouad AF, Gopal P, Hatten BW, Lang MS, Patton LL, Paumier T, Suda KJ, Cho H, Carrasco-Labra A. Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess: Systematic review and meta-analysis-a report of the American Dental Association. J Am Dent Assoc 2019; 150:e179-e216. [PMID: 31761029 DOI: 10.1016/j.adaj.2019.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with pulpal and periapical conditions often seek treatment for pain, intraoral swelling, or both. Even when definitive, conservative dental treatment (DCDT) is an option, antibiotics are often prescribed. The purpose of this review was to summarize available evidence regarding the effect of antibiotics, either alone or as adjuncts to DCDT, to treat immunocompetent adults with pulpal and periapical conditions, as well as additional population-level harms associated with antibiotic use. TYPE OF STUDIES REVIEWED The authors updated 2 preexisting systematic reviews to identify newly published randomized controlled trials. They also searched for systematic reviews to inform additional harm outcomes. They conducted searches in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. Pairs of reviewers independently conducted study selection, data extraction, and assessment of risk of bias and certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS The authors found no new trials via the update of the preexisting reviews. Ultimately, 3 trials and 8 additional reports proved eligible for this review. Trial estimates for all outcomes suggested both a benefit and harm over 7 days (very low to low certainty evidence). The magnitude of additional harms related to antibiotic use for any condition were potentially large (very low to moderate certainty evidence). CONCLUSIONS AND PRACTICAL IMPLICATIONS Evidence for antibiotics, either alone or as adjuncts to DCDT, showed both a benefit and a harm for outcomes of pain and intraoral swelling and a large potential magnitude of effect in regard to additional harm outcomes. The impact of dental antibiotic prescribing requires further research.
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18
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Longitudinal antibiotic prescribing trends among US dental specialists within a pharmacy benefits manager, 2013 through 2015. J Am Dent Assoc 2019; 150:846-853.e5. [PMID: 31561761 DOI: 10.1016/j.adaj.2019.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 05/19/2019] [Accepted: 05/22/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Reducing inappropriate antibiotic prescriptions (Rxs) is a major quality improvement initiative in the United States. Tracking antibiotic prescribing trends is 1 method of assessing improvement in antibiotic prescribing. The purpose of this study was to assess longitudinal antibiotic prescribing practices among dental specialists. METHODS This was a retrospective ecological longitudinal trend study. The authors calculated monthly systemic antibiotic Rx counts, and rates per 100,000 beneficiaries, from a pharmacy benefits manager in the United States from 2013 through 2015. The authors calculated average annual antibiotic Rx rates (AARs) for the 3-year study period. The authors used a quasi-Poisson regression model to analyze antibiotic Rx trends. The authors quantified seasonal trends, when present, via peak-to-trough ratios (PTTRs). RESULTS Dental specialists prescribed 2.4 million antibiotics to the cohort of 38 million insurance beneficiaries during the 3-year study period (AAR = 2,086 Rxs per 100,000 beneficiaries). Oral and maxillofacial surgeons prescribed the most antibiotics (1,172,104 Rxs; AAR = 1,018 Rxs per 100,000 beneficiaries), followed by periodontists (527,038 Rxs; AAR = 457 Rxs per 100,000 beneficiaries), and endodontists (447,362 Rxs; AAR = 388 Rxs per 100,000 beneficiaries). Longitudinal antibiotic prescribing trends were stable among all dental specialties in the regression models (P > .05). The authors observed substantial seasonal variation in antibiotic Rxs in 2 specialties: pediatric dentistry (PTTR, 1.18; 95% confidence interval, 1.13 to 1.25) and orthodontics and dentofacial orthopedics (PTTR, 1.41; 95% confidence interval, 1.21 to 1.71), with the highest rates of antibiotic Rxs in the spring and winter. CONCLUSIONS Antibiotic prescribing practices for dental specialists remained stable. The authors observed seasonal trends in 2 specialties. PRACTICAL IMPLICATIONS Public health efforts are needed improve antibiotic prescribing among dental specialties.
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19
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Suda KJ, Calip GS, Zhou J, Rowan S, Gross AE, Hershow RC, Perez RI, McGregor JC, Evans CT. Assessment of the Appropriateness of Antibiotic Prescriptions for Infection Prophylaxis Before Dental Procedures, 2011 to 2015. JAMA Netw Open 2019; 2:e193909. [PMID: 31150071 PMCID: PMC6547109 DOI: 10.1001/jamanetworkopen.2019.3909] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/27/2019] [Indexed: 12/12/2022] Open
Abstract
Importance Antibiotics are recommended before certain dental procedures in patients with select comorbidities to prevent serious distant site infections. Objective To assess the appropriateness of antibiotic prophylaxis before dental procedures using Truven, a national integrated health claims database. Design, Setting, and Participants Retrospective cohort study. Dental visits from 2011 to 2015 were linked to medical and prescription claims from 2009 to 2015. The dates of analysis were August 2018 to January 2019. Participants were US patients with commercial dental insurance without a hospitalization or extraoral infection 14 days before antibiotic prophylaxis (defined as a prescription with ≤2 days' supply dispensed within 7 days before a dental visit). Exposures Presence or absence of cardiac diagnoses and dental procedures that manipulated the gingiva or tooth periapex. Main Outcomes and Measures Appropriate antibiotic prophylaxis was defined as a prescription dispensed before a dental visit with a procedure that manipulated the gingiva or tooth periapex in patients with an appropriate cardiac diagnosis. To assess associations between patient or dental visit characteristics and appropriate antibiotic prophylaxis, multivariable logistic regression was used. A priori hypothesis tests were performed with an α level of .05. Results From 2011 to 2015, antibiotic prophylaxis was prescribed for 168 420 dental visits for 91 438 patients (median age, 63 years; interquartile range, 55-72 years; 57.2% female). Overall, these 168 420 dental visits were associated with 287 029 dental procedure codes (range, 1-14 per visit). Most dental visits were classified as diagnostic (70.2%) and/or preventive (58.8%). In 90.7% of dental visits, a procedure was performed that would necessitate antibiotic prophylaxis in high-risk cardiac patients. Prevalent comorbidities include prosthetic joint devices (42.5%) and cardiac conditions at the highest risk of adverse outcome from infective endocarditis (20.9%). Per guidelines, 80.9% of antibiotic prophylaxis prescriptions before dental visits were unnecessary. Clindamycin was more likely to be unnecessary relative to amoxicillin (odds ratio [OR], 1.10; 95% CI, 1.05-1.15). Prosthetic joint devices (OR, 2.31; 95% CI, 2.22-2.41), tooth implant procedures (OR, 1.66; 95% CI, 1.45-1.89), female sex (OR, 1.21; 95% CI, 1.17-1.25), and visits occurring in the western United States (OR, 1.15; 95% CI, 1.06-1.25) were associated with unnecessary antibiotic prophylaxis. Conclusion and Relevance More than 80% of antibiotics prescribed for infection prophylaxis before dental visits were unnecessary. Implementation of antimicrobial stewardship in dental practices is an opportunity to improve antibiotic prescribing for infection prophylaxis.
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Affiliation(s)
- Katie J. Suda
- College of Pharmacy, University of Illinois at Chicago
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois
| | | | - Jifang Zhou
- College of Pharmacy, University of Illinois at Chicago
| | - Susan Rowan
- College of Dentistry, University of Illinois at Chicago
| | - Alan E. Gross
- College of Pharmacy, University of Illinois at Chicago
| | - Ronald C. Hershow
- School of Public Health, University of Illinois at Chicago
- College of Medicine, University of Illinois at Chicago
| | - Rose I. Perez
- College of Medicine, University of Illinois at Chicago
| | - Jessina C. McGregor
- Oregon State University, Corvallis
- College of Pharmacy, Oregon Health and Science University, Portland
| | - Charlesnika T. Evans
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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20
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Spivak ES. Antibiotic Use in Dentistry-What We Know and Do Not Know. JAMA Netw Open 2019; 2:e193881. [PMID: 31150066 DOI: 10.1001/jamanetworkopen.2019.3881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Emily S Spivak
- Division of Infectious Diseases, Department of Medicine, University of Utah School of Medicine, Salt Lake City
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21
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Chua KP, Fischer MA, Linder JA. Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study. BMJ 2019; 364:k5092. [PMID: 30651273 PMCID: PMC6334180 DOI: 10.1136/bmj.k5092] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the appropriateness of outpatient antibiotic prescribing for privately insured children and non-elderly adults in the US using a comprehensive classification scheme of diagnosis codes in ICD-10-CM (international classification of diseases-clinical modification, 10th revision), which replaced ICD-9-CM in the US on 1 October 2015. DESIGN Cross sectional study. SETTING MarketScan Commercial Claims and Encounters database, 2016. PARTICIPANTS 19.2 million enrollees aged 0-64 years. MAIN OUTCOME MEASURES A classification scheme was developed that determined whether each of the 91 738 ICD-10-CM diagnosis codes "always," "sometimes," or "never" justified antibiotics. For each antibiotic prescription fill, this scheme was used to classify all diagnosis codes in claims during a look back period that began three days before antibiotic prescription fills and ended on the day fills occurred. The main outcome was the proportion of fills in each of four mutually exclusive categories: "appropriate" (associated with at least one "always" code during the look back period, "potentially appropriate" (associated with at least one "sometimes" but no "always" codes), "inappropriate" (associated only with "never" codes), and "not associated with a recent diagnosis code" (no codes during the look back period). RESULTS The cohort (n=19 203 264) comprised 14 571 944 (75.9%) adult and 9 935 791 (51.7%) female enrollees. Among 15 455 834 outpatient antibiotic prescription fills by the cohort, the most common antibiotics were azithromycin (2 931 242, 19.0%), amoxicillin (2 818 939, 18.2%), and amoxicillin-clavulanate (1 784 921, 11.6%). Among these 15 455 834 fills, 1 973 873 (12.8%) were appropriate, 5 487 003 (35.5%) were potentially appropriate, 3 592 183 (23.2%) were inappropriate, and 4 402 775 (28.5%) were not associated with a recent diagnosis code. Among the 3 592 183 inappropriate fills, 2 541 125 (70.7%) were written in office based settings, 222 804 (6.2%) in urgent care centers, and 168 396 (4.7%) in emergency departments. In 2016, 2 697 918 (14.1%) of the 19 203 264 enrollees filled at least one inappropriate antibiotic prescription, including 490 475 out of 4 631 320 children (10.6%) and 2 207 173 out of 14 571 944 adults (15.2%). CONCLUSIONS Among all outpatient antibiotic prescription fills by 19 203 264 privately insured US children and non-elderly adults in 2016, 23.2% were inappropriate, 35.5% were potentially appropriate, and 28.5% were not associated with a recent diagnosis code. Approximately 1 in 7 enrollees filled at least one inappropriate antibiotic prescription in 2016. The classification scheme could facilitate future efforts to comprehensively measure outpatient antibiotic appropriateness in the US, and it could be adapted for use in other countries that use ICD-10 codes.
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Affiliation(s)
- Kao-Ping Chua
- Department of Pediatrics, Child Health Evaluation and Research Center, University of Michigan Medical School, 300 N Ingalls Street, SPC 5456 Room 6E18, Ann Arbor, MI 48109-5456, USA
| | - Michael A Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeffrey A Linder
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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