National Trends in Emergency Department Antibiotic Prescribing for Elders with Urinary Tract Infection, 1996-2005
National Trends in Emergency Department Antibiotic Prescribing for Elders with Urinary Tract Infection, 1996-2005
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DOI：
10.1111/j.1553-2712.2009.00353.x
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发表时间：
2009-06-01
影响因子：
4.4
通讯作者：
Camargo, Carlos A., Jr.
中科院分区：
文献类型：
--
作者：
Caterino, Jeffrey M.;Weed, Sarah Grace;Camargo, Carlos A., Jr.
考虑到有报道称患有尿路感染（UTI）和肾盂肾炎的老年人对抗生素的耐药性增加，作者确定了1996年至2005年全国老年人急诊科（艾德）处方甲氧苄啶-磺胺甲恶唑（TMP-SMX）和氟喹诺酮类药物的比率和趋势。2005年全国医院门诊医疗服务调查（NHAMCS）。作者纳入了年龄≥ 18岁诊断为UTI或肾盂肾炎的NHAMCS艾德条目;排除了妊娠。记录分为18-64岁（“成年人”）和>= 65岁（“老年人”）。主要结果指标为TMP-SMX单药治疗、氟喹诺酮单药治疗和两种或多种抗生素联合治疗的处方。从1996年到2005年，有500万老年艾德因UTI或肾盂肾炎就诊。约9.4%（95%置信区间[CI] = 7.9%-11%）的老年人接受TMP-SMX单药治疗，发生率随时间推移而降低（趋势p值= 0.031）。总体而言，35%（95% CI = 32%-38%）的老年人接受氟喹诺酮单药治疗，从1996年的21%（95% CI = 14%-27%）增加到2005年的45%（95% CI = 39%-50%）（趋势p值< 0.001）。仅4.2%（95%CI = 3.1%~ 5.3%）的老年患者使用氟喹诺酮类药物联合第二种抗生素治疗。从1996年到2005年，老年艾德患者中TMP-SMX单药治疗减少，而氟喹诺酮类药物治疗增加。大多数接受氟喹诺酮类药物治疗的老年患者接受单药治疗。鉴于UTI或肾盂肾炎的老年艾德患者单药治疗的持续流行，应更好地描述这些患者的抗生素耐药模式，以确保适当的经验性治疗。
Given reported increases in antibiotic resistance among elders with urinary tract infection (UTI) and pyelonephritis, the authors identified national rates and trends in emergency department (ED) trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolone prescribing for older adults from 1996 to 2005.This was a retrospective analysis utilizing the ED component of the 1996-2005 National Hospital Ambulatory Medical Care Survey (NHAMCS). The authors included NHAMCS ED entries aged >= 18 years with a diagnosis of UTI or pyelonephritis; pregnancy was excluded. Records were divided into 18-64 years ("adults") and >= 65 years ("elders"). Primary outcome measures were prescription of TMP-SMX monotherapy, fluoroquinolone monotherapy, and combination therapy with two or more antibiotics. Estimated visit totals and rates were calculated and trends analyzed.From 1996 to 2005, there were 5 million elder ED visits for UTI or pyelonephritis. Approximately 9.4% (95% confidence interval [CI] = 7.9% to 11%) of elders received TMP-SMX monotherapy with rates decreasing over time (p-value for trend = 0.031). Overall, 35% (95% CI = 32% to 38%) of elders received fluoroquinolone monotherapy, which increased from 21% (95% CI = 14% to 27%) in 1996 to 45% (95% CI = 39% to 50%) in 2005 (p-value for trend < 0.001). Therapy with a fluoroquinolone plus a second antibiotic was used in only 4.2% (95% CI = 3.1% to 5.3%) of older patients.From 1996 to 2005, TMP-SMX monotherapy in elder ED patients decreased while fluoroquinolone therapy increased. The majority of older patients receiving fluoroquinolone therapy received a single agent. Given the continued prevalence of monotherapy for elder ED patients with UTI or pyelonephritis, antibiotic resistance patterns in these patients should be better characterized to ensure institution of appropriate empiric therapy.