Abstract: TH-PO908
Comparison of Outpatient Antibiotic Use in Dialysis Units of NY State
Session Information
- Dialysis: Infection
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 610 Dialysis: Infection
Authors
- Rakhman, Ilay, Mount Sinai Hospital, Elmhurst, New York, United States
- Stern, Aaron S., Mount Sinai Hospital, Elmhurst, New York, United States
- Adjei-Bosompem, Tina, Mount Sinai Hospital, Elmhurst, New York, United States
- Coritsidis, George N., Elmhurst Hospital Center, Elmhurst, New York, United States
- Lubowski, Teresa, IPRO, Lake Success, New York, United States
- Lee, Ti-Kuang, IPRO, Lake Success, New York, United States
- Lyden, Carol, ESRD Network 2, Lake Success, New York, United States
Background
Little information is available regarding oral antibiotic use in outpatient clinical dialysis settings. Our study compares different prescribing practices in end stage renal disease (ESRD) patients and non-ESRD patients in both rural and urban areas.
Methods
2015 IPRO Medicare part D data from all 62 New York State (NYS) counties were reviewed to obtain oral antibiotic (ABX) prescription information for the ESRD and non-ESRD populations. The average number of prescribed ABX per patient and average number of prescription days were compared between rural and urban areas as well as ESRD and non-ESRD populations.
Results
We found that ESRD patients were prescribed significantly more ABXs than non-ESRD patients in NYS regardless of urban or rural setting. The average number of ABX prescription days was greater with ESRD patients compared to non-ESRD patients, primarily in urban areas. Urban patients were prescribed Ampicillin (p=0.0295), Cefeclor (p=0.464), Cefadroxil (p=0.003), Dicloxacillin (p=0.018), and Metronidazole (p=0.0078) more often. Rural patients were prescribed Cefpodoxime 3.5 times more often than urban ESRD patients.
Conclusion
ESRD patients are prescribed more antibiotics for a longer duration when compared to the general population. Differences in prescribing patterns could be explained by more judicious prescription practices, less diversity of prescribers, fewer individual prescribers or the clinical status of ESRD patients. We cannot yet answer the question of appropriateness of antibiotic prescriptions, but these data can help establish prescription patterns, which can then be applied more broadly. Ultimately the data can be used to modify prescribing practices using evidence based recommendations to decrease inappropriate antibiotic use and promote antibiotic stewardship.
Table 1. Comparison of Antibiotics Prescribing Patterns Between ESRD Non-ESRD Patients
| Non-ESRD | ESRD | p | |
| Avg ABX prescribed per patient | 0.89 ± 0.02 | 1.66 ± 0.06 | <0.001 |
| Rural | 0.87 ± 0.04 | 1.79 ± 0.25 | 0.003 |
| Urban | 0.89 ± 0.02 | 1.63 ± 0.04 | <0.001 |
| Avg days ABX prescribed per patient | 10.27 ± 0.92 | 13.30 ± 0.41 | <0.001 |
| Rural | 10.61 ± 0.18 | 12.70 ± 1.43 | 0.171 |
| Urban | 10.17 ± 0.10 | 13.46 ± 0.37 | <0.001 |