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The association of patient complexities with antibiotic ordering
Published Web Location
https://pubmed.ncbi.nlm.nih.gov/25873035/No data is associated with this publication.
Abstract
Background
Antibiotic treatment decisions for medically complex patients are complicated, as the risk of undertreatment may be severe, whereas overtreatment may be associated with adverse effects and the emergence of antibiotic resistant pathogens.Objective
To determine the influence of patient complexities on providers' decisions to prescribe antibiotics in 3 common hospital-based clinical vignettes.Design
A physician survey.Setting
Three urban medical centers in Los Angeles County, California.Participants
Hospital-based physicians.Measurements
Physicians were presented 3 clinical vignettes, with variations by patient age, comorbidity burden, functional status, and follow-up, and asked to choose the best antibiotic regimen. We described the association of additional patient complexity on the proportion of guideline-adherent antibiotic choices.Results
In the survey, 28% to 49% of physicians recommended antibiotics that were inconsistent with national guidelines. This percentage increased to 48% to 63% for medically complex patients, defined as those with either older age, high medical comorbidity burden, poor functional status, or limited follow-up after hospital discharge (P < 0.01).Conclusions
In 3 vignettes depicting common clinical scenarios among hospitalized adults, inappropriate antibiotic use was prevalent and occurred more often for patients with medical complexities. Treatment guidelines should consider addressing medically complex patients in the context of infection management.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.