National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections
National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections
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DOI：
10.1001/archinte.168.14.1585
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发表时间：
2008-07-28
影响因子：
--
通讯作者：
Gonzales, Ralph
中科院分区：
文献类型：
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作者：
Hersh, Adam L.;Chambers, Henry F.;Gonzales, Ralph
背景资料：社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）已成为美国皮肤和软组织感染（SSTI）的常见原因。目前还不清楚这一发展是否影响了全国的访问率，初级保健的做法和急诊科（ED），是否在抗生素处方的变化已经happened.Methods：我们检查了访问与SSTI患者的医生办公室，医院门诊部，和ED使用全国门诊医疗服务调查和全国医院门诊医疗服务调查，从1997年至2005年。我们估计了所有SSTI和脓肿/蜂窝织炎亚组的年就诊率。对于脓肿/蜂窝织炎的访问，我们研究了患者和临床环境的特点，并在抗生素prescription.Results的趋势：访问SSTI的总体率从32.1增加到48.1访问每1000人口（50%，P = 0.003的趋势），达到14.2万，到2005年。超过95%的变化归因于脓肿/蜂窝织炎的就诊，从每1000人17.3次增加到32.5次（趋势增加88%，P <0.001）。最大的相对增加发生在ED（特别是在高安全网地位的ED和南方），黑人患者和18岁以下的患者中。在研究期间，推荐用于CA-MRSA的抗生素的使用从7%增加到28%（P <0.001）。这些抗生素治疗的独立预测因素包括年龄小于45岁，生活在南方，和一个艾德setting.Conclusions：SSTI的发病率在全国范围内迅速增加，在CA-MRSA时代，似乎不成比例地影响某些人群。虽然医生开始修改抗生素处方实践，但仍存在改进的机会，目标是照顾高风险患者的医生。
Background: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a common cause of skin and soft-tissue infections (SSTIs) in the United States. It is unknown whether this development has affected the national rate of visits to primary care practices and emergency departments (EDs) and whether changes in antibiotic prescribing have occurred.Methods: We examined visits by patients with SSTIs to physician offices, hospital outpatient departments, and EDs using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1997 to 2005. We estimated annual visit rates for all SSTIs and a subset classified as abscess/cellulitis. For abscess/cellulitis visits, we examined trends in characteristics of patients and clinical settings and in antibiotic prescribing.Results: Overall rate of visits for SSTIs increased from 32.1 to 48.1 visits per 1000 population (50%; P = .003 for trend), reaching 14.2 million by 2005. More than 95% of this change was attributable to visits for abscess/ cellulitis, which increased from 17.3 to 32.5 visits per 1000 population (88% increased P < .001 for trend). The largest relative increases occurred in EDs (especially in high safety-net-status EDs and in the South), among black patients, and among patients younger than 18 years. Use of antibiotics recommended for CA-MRSA increased from 7% to 28% of visits (P < .001) during the study period. Independent predictors of treatment with these antibiotics included being younger than 45 years, living in the South, and an ED setting.Conclusions: The incidence of SSTIs has rapidly increased nationwide in the CA-MRSA era and appears to disproportionately affect certain populations. Although physicians are beginning to modify antibiotic prescribing practices, opportunities for improvement exist, targeting physicians caring for patients who are at high risk.