Assessment of Guideline Discordance With Antimicrobial Prophylaxis Best Practices for Common Urologic Procedures

Autor: Chelsea Khaw, Brett H. Heintz, Brian C. Lund, Anthony D. Oberle, Jason A Egge, Bradley A. Erickson, Daniel J. Livorsi
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Zdroj: JAMA Network Open
ISSN: 2574-3805
Popis: Key Points Question Do urologic clinicians within the Veterans Health Administration system adhere to the American Urological Association’s antimicrobial prophylaxis guideline for endoscopic urologic procedures? Findings In this cohort study analyzing the medical records of 375 patients at 5 Veterans Health Administration hospitals and the administrative data of 29 530 records throughout the entire Veterans Health Administration system, antimicrobial prescribing was guideline discordant in nearly 60% of patients, the rate of excessive postprocedural antimicrobial use was high, and nearly 40% of records received a median of 3 excess days of antimicrobial therapy. Agreement between these 2 data sources was high. Meaning In patients who underwent common urologic procedures, the rates of guideline-discordant antimicrobial use were high, mainly because of overprescribing of postprocedural antimicrobial agents.
Importance The American Urological Association guidelines recommend 24 or fewer hours of antimicrobial prophylaxis for most urologic procedures. Continuing antimicrobial therapy beyond 24 hours may carry more risks than advantages. Objectives To assess guideline discordance of antimicrobial prophylaxis for common urologic endoscopic procedures, and to identify opportunities for improving antimicrobial prescribing through future stewardship interventions. Design, Setting, and Participants This multicenter cohort study conducted manual audits of medical records of 375 patients who underwent 1 of 3 urologic procedures (transurethral resection of bladder tumor [TURBT], transurethral resection of the prostate [TURP], and ureteroscopy [URS]) at 5 Veterans Health Administration facilities from January 1, 2016, to June 30, 2017. Antimicrobial prescribing practices across the national Veterans Health Administration system were assessed using the administrative data for 29 530 records. Main Outcomes and Measures Guideline discordance was assessed in the medical record review. Excessive postprocedural antimicrobial use was measured in the national administrative data analysis. Results The medical records of a total of 375 patients were manually reviewed. Among the 375 patients, 366 (97.6%) were male and 9 (2.4%) were female, with a mean (SD) age of 64.2 (10.9) years and a predominantly white race/ethnicity (289 [77.1%]). In addition, 29 530 patient records in the national administrative database were assessed. Among the patient records, 28 938 (98.0%) were male and 592 (2.0%) were female with a mean (SD) age of 69.1 (10.2) years and a predominantly white race/ethnicity (23 297 [78.9%]). Among the manually reviewed medical records, periprocedural or postprocedural antimicrobial prescribing was guideline discordant in 217 patients (57.9%). Postprocedural antimicrobial agents were continued beyond 24 hours in 211 patients (56.3%) and were guideline discordant in 177 patients (83.9%), with a median (interquartile range) duration of 3 (3-5) days of unnecessary antimicrobial therapy. In the analysis of national administrative data, excessive postprocedural antimicrobial agents were prescribed in 10 988 of 29 350 patient records (37.2%), with a median (interquartile range) of 3 (2-6) excess days. For any given facility, a statistically significant correlation was observed in the frequency of postprocedural antimicrobial prescribing between any 2 procedures, indicating that facilities with higher rates of excessive use for 1 procedure also had higher rates for another procedure: TURP and TURBT (ρ = 0.719; 95% CI, 0.603-0.803; P
This cohort study evaluates the use of and prescribing patterns for antimicrobial medications in patients who underwent urologic procedures at Veterans Health Administration hospitals.
Databáze: OpenAIRE
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