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Abstract: SA-PO1000

Analysis of Dual-State Antibiotic Prescription Practices in the ESRD Population

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Rakhman, Ilay, Elmhurst Hospital, Queens, New York, United States
  • Yaphe, Sean, Elmhurst Hospital Center , Elmhurst, New York, United States
  • Munro, Carly E., Maimonides Medical Center, Brooklyn, New York, United States
  • Stern, Aaron S., Elmhurst Hospital Center , Elmhurst, New York, United States
  • Lubowski, Teresa, IPRO, Albany, New York, United States
  • Lee, Ti-Kuang, IPRO, Albany, New York, United States
  • Coritsidis, George N., Elmhurst Hospital Center , Elmhurst, New York, United States
Background

We previously analyzed outpatient oral antibiotic prescriptions (ABP) for end-stage renal disease patients on hemodialysis (ESRD) in New York State (NYS). Nearly 50% of ABPs had no associated infectious diagnosis. Here, we compare ABPs between NYS and South Carolina (SC).

Methods

2018 NYS and SC Medicare part B and D data were collected and linked to ICD-10 diagnosis (DX) codes. Patients under 18 years of age, on peritoneal dialysis, or who had chronic kidney disease were excluded. ICD-10 codes were classified into 14 DXs. Chi-square analysis was used to compare data between NYS and SC.

Results

Table 1 presents the top 5 infection DXs. Incidence of ABPs was 619.9/1000 patients in NYS compared with 597.3/1000 patients in SC. In both states nearly 40% of ABP were categorized as nonspecific symptoms or had no DX. The top 10 ABPs were also similar between states (Table 2). Trimethoprim-sulfamethoxazole was prescribed often in both states despite not being recommended in ESRD.

Conclusion

Antibiotic selection and sources of infection were similar in both states, and indications are often not clear. This suggests that antibiotic guidelines in ESRD is a national problem. The number of skin infections may reflect access complications.

Table 1: Top 5 Infectious Diagnosis
 NYSSCP
Respiratory19.48%19.96%0.39
Nonspecific symptoms19.11%17.40%< 0.05
No diagnosis18.48%21.79%< 0.05
Skin17.74%17.79%0.95
GU6.81%8.72%< 0.05
Other18.38%14.34% 
Table 2: Top 10 Antibiotics
 NYSSCP
Levofloxacin11.50%11.02%0.29
Azithromycin11.45%10.74%0.12
Amoxicillin-Clavulanate10.93%8.82%< 0.05
Doxycycline10.27%12.44%< 0.05
Cephalexin9.69%11.81%< 0.05
Ciprofloxacin9.33%10.70%< 0.05
Sulfamethoxazole-Trimethoprim7.04%7.36%0.39
Amoxicillin6.97%6.72%0.51
Metronidazole4.48%4.98%0.10
Clindamycin3.66%5.34%< 0.05
Other14.68%10.07%