Variability of Antibiotic Prescribing in a Large Healthcare Network Despite Adjusting for Patient-Mix: Reconsidering Targets for Improved Prescribing.


Background:In the outpatient setting, the majority of antibiotic prescriptions are for acute respiratory infections (ARIs), but most of these infections are viral and antibiotics are unnecessary. We analyzed provider-specific antibiotic prescribing in a group of outpatient clinics affiliated with an academic medical center to inform future interventions to minimize unnecessary antibiotic use. Methods:We conducted a cross-sectional study of patients who presented with an ARI to any of 15 The Emory Clinic (TEC) primary care clinic sites between October 2015 and September 2017. We performed multivariable logistic regression analysis to examine the impact of patient, provider, and clinic characteristics on antibiotic prescribing. We also compared provider-specific prescribing rates within and between clinic sites. Results:A total of 53.4% of the 9600 patient encounters with a diagnosis of ARI resulted in an antibiotic prescription. The odds of an encounter resulting in an antibiotic prescription were independently associated with patient characteristics of white race (adjusted odds ratio [aOR] = 1.59; 95% confidence interval [CI], 1.47-1.73), older age (aOR = 1.32, 95% CI = 1.20-1.46 for patients 51 to 64 years; aOR = 1.32, 95% CI = 1.20-1.46 for patients ≥65 years), and comorbid condition presence (aOR = 1.19; 95% CI, 1.09-1.30). Of the 109 providers, 13 (12%) had a rate significantly higher than predicted by modeling. Conclusions:Antibiotic prescribing for ARIs within TEC outpatient settings is higher than expected based on prescribing guidelines, with substantial variation in prescribing rates by site and provider. These data lay the foundation for quality improvement interventions to reduce unnecessary antibiotic prescribing.


Open Forum Infect Dis


Jung S,Sexton ME,Owens S,Spell N,Fridkin S




Has Abstract


2019-01-18 00:00:00












  • The Cefazolin Inoculum Effect Is Associated With Increased Mortality in Methicillin-Susceptible Staphylococcus aureus Bacteremia.

    abstract:Background:Recent studies have favored the use of cefazolin over nafcillin for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. The clinical influence of the cefazolin inoculum effect (CzIE) in the effectiveness of cephalosporins for severe MSSA infections has not been evaluated. Metho...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Miller WR,Seas C,Carvajal LP,Diaz L,Echeverri AM,Ferro C,Rios R,Porras P,Luna C,Gotuzzo E,Munita JM,Nannini E,Carcamo C,Reyes J,Arias CA

    更新日期:2018-05-23 00:00:00

  • Pericarditis Associated With Acute Zika Virus Infection in a Returning Traveler.

    abstract::Despite the widespread outbreak, few cases of Zika virus associated with cardiac manifestations have been described. We present a case of pericarditis in the setting of an acute, symptomatic Zika virus infection in a traveler returning from St. Thomas. Clinicians should be alert for this potential complication of Zika...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Waggoner JJ,Rouphael N,Xu Y,Natrajan M,Lai L,Patel SM,Levit RD,Edupuganti S,Mulligan MJ

    更新日期:2017-05-18 00:00:00

  • What's Hot in Clinical Infectious Diseases? 2019 IDWeek Summary.

    abstract::The year 2019 brought about a multitude of innovations in clinical infectious diseases. With the continued rise of antimicrobial resistance (AMR), advances in diagnostics and newly available antibiotics offer additional strategies for combating this threat, but the broken antibiotic market serves as an impediment to f...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章,评审


    authors: Moss S,Boucher HW

    更新日期:2020-03-23 00:00:00

  • Perioperative Bacterial Contamination From Patients on Contact Precaution in Operating Room Environment.

    abstract::We investigated the microbial burden on the operating room environment when patients on contact precautions for a multidrug-resistant pathogen received surgery. Our study demonstrated that the perioperative environment was contaminated with aerobic bacteria and methicillin-resistant Staphylococcus aureus (MRSA) after ...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Kanamori H,Rutala WA,Gergen MF,Weber DJ

    更新日期:2020-10-27 00:00:00

  • Point-of-Use Mixing of Influenza H5N1 Vaccine and MF59 Adjuvant for Pandemic Vaccination Preparedness: Antibody Responses and Safety. A Phase 1 Clinical Trial.

    abstract:BACKGROUND:Avian influenza A/H5N1 has threatened human health for nearly 2 decades. Avian influenza A vaccine without adjuvant is poorly immunogenic. A flexible rapid tactic for mass vaccination will be needed if a pandemic occurs. METHODS:A multicenter, randomized, blinded phase 1 clinical trial evaluated safety and ...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Mulligan MJ,Bernstein DI,Frey S,Winokur P,Rouphael N,Dickey M,Edupuganti S,Spearman P,Anderson E,Graham I,Noah DL,Mangal B,Kim S,Hill H,Whitaker J,Emery W,Beck A,Stephens K,Hartwell B,Ogilvie M,Rimann N,Osinski

    更新日期:2014-11-18 00:00:00

  • Antimicrobial Management of Respiratory Infections in Severe Acute Respiratory Syndrome Coronavirus 2 Patients: Clinical and Antimicrobial Stewardship Programs Conundrums.

    abstract::The role of empirical and even directed antimicrobial management of patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is problematic; antibiotics are used frequently among these patients to treat confirmed or suspected coinfection or just the symptoms. In the rapidly cha...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Goldstein EJC,Tillotson G,Redell M

    更新日期:2020-10-26 00:00:00

  • Trends in Kindergarten Rates of Vaccine Exemption and State-Level Policy, 2011-2016.

    abstract:Background:Kindergarten-entry vaccination requirements have played an important role in controlling vaccine-preventable diseases in the United States. Forty-eight states and the District of Colombia offer nonmedical exemptions to vaccines, ranging in stringency. Methods:We analyzed state-level exemption data from 2011...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Omer SB,Porter RM,Allen K,Salmon DA,Bednarczyk RA

    更新日期:2017-11-15 00:00:00

  • Trends in Hospitalizations Related to Invasive Aspergillosis and Mucormycosis in the United States, 2000-2013.

    abstract:BACKGROUND:Invasive aspergillosis (IA) and mucormycosis contribute to substantial mortality, especially among immunocompromised persons, including those with hematopoietic stem cell transplant (HSCT), hematologic malignancy (HM), and solid organ transplant (SOT). METHODS:Using International Classification of Diseases,...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Vallabhaneni S,Benedict K,Derado G,Mody RK

    更新日期:2017-01-13 00:00:00

  • I-FABP Is Higher in People With Chronic HIV Than Elite Controllers, Related to Sugar and Fatty Acid Intake and Inversely Related to Body Fat in People With HIV.

    abstract:Background:Intestinal fatty acid binding protein (I-FABP) has been shown to be a marker of intestinal damage among people living with HIV. We hypothesized that I-FABP would be increased in chronically HIV-infected patents more than elite controllers and would relate to specific nutrient intake and body composition. Me...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Cheru LT,Park EA,Saylor CF,Burdo TH,Fitch KV,Looby S,Weiner J,Robinson JA,Hubbard J,Torriani M,Lo J

    更新日期:2018-11-05 00:00:00

  • Sustained Response and Rationale of Programmed Cell Death-1-Targeting for Progressive Multifocal Leukoencephalopathy.

    abstract::In this study, we report a complete (clinical, radiological, and virological) sustained (1 year) response after nivolumab salvage therapy in a progressive multifocal leukoencephalopathy patient. Analyses of the cells infiltrate in a pretreatment brain biopsy suggest that parenchymal programmed cell death-L1+ macrophag...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Audemard-Verger A,Gasnault J,Faisant M,Besse MC,Martin-Silva N,Berra M,Fournier L,Boutemy J,Maigne G,De Boysson H,Ruet A,Vabret A,Chapon F,Martin-Blondel G,Aouba A

    更新日期:2019-09-30 00:00:00

  • Hepatitis E Virus Infection Among Solid Organ Transplant Recipients at a North American Transplant Center.

    abstract::Background.  Autochthonous hepatitis E virus (HEV) infection has been reported in over 200 solid organ transplant (SOT) recipients since 2006, yet little is known about the burden of HEV among SOT recipients in North America. We performed a retrospective, cross-sectional study to investigate the prevalence and risk fa...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Sue PK,Pisanic N,Heaney CD,Forman M,Valsamakis A,Jackson AM,Ticehurst JR,Montgomery RA,Schwarz KB,Nelson KE,Karnsakul W

    更新日期:2016-01-18 00:00:00

  • Correlation Between Tenofovir Drug Levels and the Renal Biomarkers RBP-4 and ß2M in the ION-4 Study Cohort.

    abstract:Background:Concomitant dosing of ledipasvir (LDV) and tenofovir disoproxil fumarate (TDF) results in an increased tenofovir (TFV) area under the curve (AUC). The aim of this study was to examine whether there was a correlation between the renal biomarkers retinol binding protein-4 (RBP-4) and β2 microglobulin (β2M) and...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Chan A,Park L,Collins LF,Cooper C,Saag M,Dieterich D,Sulkowski M,Naggie S

    更新日期:2019-01-24 00:00:00

  • Diabetes Modifies the Clinic Presentation of Cutaneous Leishmaniasis.

    abstract:Background:Cutaneous leishmaniasis (CL) caused by L. braziliensis is characterized by 1 or multiple well-limited ulcerated lesions. Diabetes mellitus (DM) impairs neutrophil and monocyte function, and there is a report of vegetative lesions in a patient with both diseases in Morocco. Here we evaluate the influence of D...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Lago AS,Lima FR,Carvalho AM,Sampaio C,Lago N,Guimarães LH,Lago J,Machado PRL,Carvalho LP,Arruda S,Carvalho EM

    更新日期:2020-10-19 00:00:00

  • Sexually Transmitted Infections Among HIV-Infected Individuals in the District of Columbia and Estimated HIV Transmission Risk: Data From the DC Cohort.

    abstract:Background:Washington, DC, has one of the highest rates of HIV infection in the United States. Sexual intercourse is the leading mode of HIV transmission, and sexually transmitted infections (STIs) are a risk factor for HIV acquisition and transmission. Methods:We evaluated the incidence and demographic factors associ...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Lucar J,Hart R,Rayeed N,Terzian A,Weintrob A,Siegel M,Parenti DM,Squires LE,Williams R,Castel AD,Benator DA,DC Cohort Executive Committee .

    更新日期:2018-01-24 00:00:00

  • Blood Culture-Negative Cardiovascular Infection in a Patient With Multiple Sclerosis.

    abstract::A patient with multiple sclerosis presented with seronegative C. burnetii endocarditis diagnosed using C. burnetii-specific polymerase chain reaction and fluorescence in situ hybridization on cardiovascular biopsy. This case supports the necessity of a systematic polymerase chain reaction testing of removed cardiac va...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Melenotte C,Loukil A,Rico A,Lepidi H,Raoult D

    更新日期:2019-10-04 00:00:00

  • Real-time Communication With Health Care Providers Through an Online Respiratory Pathogen Laboratory Report.

    abstract::We implemented a real-time report to distribute respiratory pathogen data for our 8-hospital system to anyone with an Internet connection and a web browser. Real-time access to accurate regional laboratory observation data during an epidemic influenza season can guide diagnostic and therapeutic strategies. ...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Christensen PA,Olsen RJ,Perez KK,Cernoch PL,Long SW

    更新日期:2018-11-30 00:00:00

  • Difficulties of Identifying the Early HIV Antibody Seroconversion Period Depending on the Confirmatory Assay.

    abstract:Background:Identification of HIV infection at the early stage is valuable for patient management, for prevention, and for research purposes. In practice, identification of a recent HIV infection at diagnosis proves challenging after HIV antibody seroconversion but can be suspected using Western blots (WBs) or immunoblo...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Stefic K,Mahjoub N,Desouche C,Néré ML,Thierry D,Delaugerre C,Barin F,Chaix ML

    更新日期:2020-04-21 00:00:00

  • Multidrug Resistant Pseudomonas aeruginosa Causing Prosthetic Valve Endocarditis: A Genetic-Based Chronicle of Evolving Antibiotic Resistance.

    abstract:: Background.  Successful treatment of infections caused by multidrug-resistant (MDR) Pseudomonas aeruginosa is thwarted by the emergence of antibiotic resistance and biofilm formation on prosthetic devices. Our aims were to decipher the molecular basis of resistance in a un...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Domitrovic TN,Hujer AM,Perez F,Marshall SH,Hujer KM,Woc-Colburn LE,Parta M,Bonomo RA

    更新日期:2016-10-21 00:00:00

  • Physical Functioning Among Patients Aging With Human Immunodeficiency Virus (HIV) Versus HIV Uninfected: Feasibility of Using the Short Physical Performance Battery in Clinical Care of People Living With HIV Aged 50 or Older.

    abstract:Background:The Short Physical Performance Battery (SPPB) is a well regarded physical functioning assessment including balance, gait speed, and chair-stand tests. Its use has not been widely assessed in human immunodeficiency virus (HIV) care. We evaluated the feasibility of integrating the SPPB into care of aging peopl...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Crane HM,Miller ME,Pierce J,Willig AL,Case ML,Wilkin AM,Brown S,Asirot MG,Fredericksen RJ,Saag MS,Landay AL,High KP

    更新日期:2019-03-11 00:00:00

  • A Subset of Extreme Human Immunodeficiency Virus (HIV) Controllers Is Characterized by a Small HIV Blood Reservoir and a Weak T-Cell Activation Level.

    abstract:BACKGROUND:Human immunodeficiency virus controllers (HICs) form a heterogeneous group of patients with regard to formal definitions, immunologic characteristics, and changes over time in viral load. PATIENTS AND METHODS:The HICs with undetectable viral load ([uHICs] ie, for whom a viral load had never been detected wi...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Canouï E,Lécuroux C,Avettand-Fenoël V,Gousset M,Rouzioux C,Saez-Cirion A,Meyer L,Boufassa F,Lambotte O,Noël N,and the ANRS CO21 CODEX Study Group.

    更新日期:2017-04-03 00:00:00

  • Serum Amyloid P Component and Systemic Fungal Infection: Does It Protect the Host or Is It a Trojan Horse?

    abstract::It is a striking observation that tissue of patients invaded by the deep mycoses often lacks evidence of an inflammatory response. This lack of host response is often attributed to neutropenia secondary to chemotherapy. However, systematic studies do not support this simplistic explanation. However, invasive fungal le...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Klotz SA,Sobonya RE,Lipke PN,Garcia-Sherman MC

    更新日期:2016-08-03 00:00:00

  • Disseminated Mycobacterium abscessus Infection Secondary to an Infected Vascular Stent: Case Report and Review of the Literature.

    abstract::Mycobacterium abscessus is a rapidly growing, multidrug-resistant mycobacteria, commonly associated with pulmonary, skin, and soft tissue infections. We describe a rare case of M abscessus endovascular stent infection; only 3 cases of graft infections have previously been reported. ...

    journal_title:Open forum infectious diseases



    authors: Tejura N,Bontempo G,Chew D

    更新日期:2018-08-23 00:00:00

  • The Cytokine Response Profile of Ebola Virus Disease in a Large Cohort of Rhesus Macaques Treated With Monoclonal Antibodies.

    abstract::Ebola virus (EBOV) is a highly pathogenic filovirus that causes outbreaks of a severe hemorrhagic fever known as EBOV disease (EVD). Ebola virus disease is characterized in part by a dysregulated immune response and massive production of both pro- and anti-inflammatory cytokines. To better understand the immune respon...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Banadyga L,Siragam V,Zhu W,He S,Cheng K,Qiu X

    更新日期:2019-02-06 00:00:00

  • Corrigendum: Hepatitis B Virus (HBV) Infection and Re-activation During Nucleos(t)ide Reverse Transcriptase Inhibitor-Sparing Antiretroviral Therapy in a High-HBV Endemicity Setting.

    abstract::[This corrects the article DOI: 10.1093/ofid/ofy251.]. ...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章,已发布勘误


    authors: Abdullahi A,Fopoussi OM,Torimiro J,Atkins M,Kouanfack C,Geretti AM

    更新日期:2019-04-03 00:00:00

  • Antibiotic Treatment Versus No Treatment for Asymptomatic Bacteriuria in Kidney Transplant Recipients: A Multicenter Randomized Trial.

    abstract:Background:Whether antibiotic treatment of asymptomatic bacteriuria (AB) can prevent acute graft pyelonephritis (AGP) in kidney transplant (KT) recipients has not been elucidated. Methods:In this multicenter, open-label, nonblinded, prospective, noninferiority, randomized controlled trial, we compared antibiotic treat...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Sabé N,Oriol I,Melilli E,Manonelles A,Bestard O,Polo C,Los Arcos I,Perelló M,Garcia D,Riera L,Tebé C,Len Ò,Moreso F,Cruzado JM,Carratalà J

    更新日期:2019-05-21 00:00:00

  • Comparison of Adverse Drug Reactions Between Patients Treated With Ceftaroline or Ceftriaxone: A Single-Center, Matched Cohort Study.

    abstract:Background:Little information is available on the relative tolerability of ceftaroline versus other cephalosporins in clinical practice. We sought to compare adverse drug reactions (ADRs) associated with ceftaroline with those associated with ceftriaxone in hospitalized patients. Materials and Methods:This was a retro...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Jansen JW,Linneman TW,Tan X,Moenster RP

    更新日期:2019-06-13 00:00:00

  • Faces of Resistance: Using Real-World Patients and Their Advocates to Teach Medical Students About Antimicrobial Stewardship.

    abstract::We engaged medical students with antimicrobial stewardship (AS) and antimicrobial resistance (AMR) through patient stories and a panel on AMR advocacy with experts from the Centers for Disease Control and Prevention and the Infectious Diseases Society of America. Students were surveyed on their perceptions about AS an...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Nori P,Cowman K,Jezek A,Nosanchuk JD,Slosar-Cheah M,Sarwar U,Bartash R,Ostrowsky B

    更新日期:2019-11-13 00:00:00

  • Atherosclerotic Cardiovascular Disease Risk Profile of Tenofovir Alafenamide Versus Tenofovir Disoproxil Fumarate.

    abstract:Background:In human immunodeficiency virus (HIV) treatment, tenofovir alafenamide (TAF) is associated with greater increases in all fasting cholesterol subgroups compared with tenofovir disoproxil fumarate (TDF). Because lipid abnormalities may contribute to cardiovascular morbidity and mortality, cardiovascular risk a...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Huhn GD,Shamblaw DJ,Baril JG,Hsue PY,Mills BL,Nguyen-Cleary T,McCallister S,Das M

    更新日期:2019-11-11 00:00:00

  • Lack of Awareness of Human Immunodeficiency Virus (HIV) Infection: Problems and Solutions With Self-reported HIV Serostatus of Men Who Have Sex With Men.

    abstract:BACKGROUND:Lack of human immunodeficiency virus (HIV) infection awareness may be a driver of racial disparities in HIV infection among men who have sex with men (MSM). Lack of awareness is typically measured by comparing HIV test result to self-reported HIV status. This measure may be subject to reporting bias and alte...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: Sanchez TH,Kelley CF,Rosenberg E,Luisi N,O'Hara B,Lambert R,Coleman R,Frew P,Salazar LF,Tao S,Clarke W,Del Rio C,Sullivan PS

    更新日期:2014-09-13 00:00:00

  • Diagnostic Value of Chest X-Ray in Patients With Suspected Infection and No Respiratory Signs or Symptoms.

    abstract::Suspicion of an infection without localizing signs or symptoms is a common problem. A chest x-ray (CXR) is often performed to rule out pneumonia. Our prospective cross-sectional study suggests that a CXR has no diagnostic value in patients without respiratory signs or symptoms, if a reliable medical history can be obt...

    journal_title:Open forum infectious diseases

    pub_type: 杂志文章


    authors: de Stoppelaar SF,Pereverzeva L,Hafkamp B,Lips N,Tielbeke F,Rustenburg L,Hoogerheide-Wiegerinck C,de Heer K

    更新日期:2020-06-08 00:00:00