Study: Ambulatory Care Clinics Prescribe Millions of Inappropriate Antibiotics

The results of a new study indicate that at least one out of every four antibiotics prescribed during ambulatory care visits were inappropriate.

The study, published in BMJ, examined data from the 2015 National Ambulatory Medical Care Survey. Researchers analyzed more than 28,000 sample visits representing close to a billion ambulatory care visits nationwide.

Their conclusions include the following:

• Antibiotics were prescribed during about 13% of ambulatory care visits in 2015.

• About 25% were for inappropriate indications (~32 million prescriptions).

• In addition, 18% lacked a documented indication (~24 million prescriptions).

• Combined, as many as 43% of prescriptions were potentially inappropriate.

• Factors contributing significantly to antibiotic prescribing without an indication were being an adult male, having at least one chronic disease, spending more time with the provider and seeing a non-primary care specialist.

• Prescriptions for sulfonamides and urinary anti-infectives were commonly associated with the absence of a documented infection.

In the study's conclusion, researchers state, "Antibiotic prescribing in the absence of a documented indication may severely bias national estimates of appropriate antibiotic use in this setting and misinform antimicrobial stewardship efforts. … With 60% of antibiotic expenditure and up to 90% of antibiotic use originating in ambulatory care settings, more focus is needed to support well informed stewardship efforts beyond the hospital."

Patient Lab Specimens Contaminated By Mycobacterium From Tap Water

A hospital's investigation into patient laboratory specimens contaminated with Mycobacterium porcinum identified tap water as the source.

The hospital laboratory identified clusters of isolates that tested positive for the nontuberculous mycobacterium from January 2017 into April 2018, according to Morbidity and Mortality Weekly Report, which is published by the U.S. Centers for Disease Control and Prevention (CDC). A total of 20 isolates was obtained from 16 patients. M. porcinum is associated with infections of the respiratory tract, bloodstream, surgical sites and soft tissue.

The investigation was conducted by the hospital's infection prevention team and the Wisconsin State Laboratory of Hygiene. Investigators eventually traced M. porcinum to two ice machines and one water dispenser. Inspection revealed debris on internal parts and dispenser spouts.

New machines and parts were installed in June 2018, and the hospital revised its cleaning protocols. Staff members no longer use tap water when collecting respiratory cultures. CDC stated no further M. porcinum patient isolates have been identified.

As the report concludes, "Tap water is not sterile, can lead to false-positive culture results and should be avoided when collecting biologic specimens intended for culture. Hospital water management programs should engage clinical partners to ensure safe water use as part of patient care and address maintenance of ice machines and water dispensers within their facilities."

FDA Hopes New App Will Help With Treatment of Infectious Diseases

The U.S. Food and Drug Administration (FDA) has launched a new app that will allow healthcare professionals to share new uses of FDA-approved drugs to treat difficult-to-treat infectious diseases.

FDA is hoping that by allowing members of the clinical community to share their experiences via the CURE ID app, this crowdsourcing platform will help guide new interventions and facilitate development of new drugs for neglected diseases.

The CURE ID app, described by the FDA as an "internet-based repository," is designed to capture clinical outcomes when medications are used for new indications, in new populations, in new doses or in new combinations. Caregivers complete a simple case report form about their experience using an approved product for an unapproved use.

The app also allows healthcare professionals to browse cases that have already been documented, including successful and unsuccessful treatments, and view relevant clinical trials and those open to enrollment at clinicaltrials.gov. Users can also participate in a treatment discussion forum with fellow providers globally.

In a news release, Dr. Amy Abernethy, FDA principal deputy commissioner, said, "Our hope is that this app will serve as a connector among major treatment centers, academics, private practitioners, government facilities and other healthcare professionals from around the world and ultimately get treatments to patients faster.”

CURE ID is a collaboration between the FDA and the National Center for Advancing Translational Sciences, which is part of the National Institutes of Health.

To download and use the CURE ID application, click here or download "CURE ID" from the App or Play Store.