Microbiology testing associated with antibiotic dispensing in older community-dwelling adults
Date
2020
Authors
Peng, Zhuoxin
Hayen, Andrew
Kirk, Martyn
Pearson, Sallie
Cheng, A.C.
Liu, Bette
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: It is commonly recommended that microbiological assessment should accompany the use of
antibiotics prone to resistance. We sought to estimate the rate of microbiology testing and compare this to
dispensing of the World Health Organization classified “watch” group antibiotics in primary care.
Methods: Data from a cohort of older adults (mean age 69 years) were linked to Australian national health
insurance (Pharmaceutical Benefits Scheme & Medicare Benefits Schedule) records of community-based antibiotic
dispensing and microbiology testing in 2015. Participant characteristics associated with greater watch group
antibiotic dispensing and microbiology testing were estimated using adjusted incidence rate ratios (aIRR) and 95%
confidence intervals (CI) in multivariable zero-inflated negative binomial regression models.
Results: In 2015, among 244,299 participants, there were 63,306 watch group antibiotic prescriptions dispensed
and 149,182 microbiology tests conducted; the incidence rate was 0.26 per person-year for watch group antibiotic
dispensing and 0.62 for microbiology testing. Of those antibiotic prescriptions, only 19% were accompanied by
microbiology testing within − 14 to + 7 days. After adjusting for socio-demographic factors and co-morbidities,
individuals with chronic respiratory diseases were more likely to receive watch group antibiotics than those without,
e.g. asthma (aIRR:1.59, 95%CI:1.52–1.66) and chronic obstructive pulmonary disease (COPD) (aIRR:2.71, 95%CI:2.48–
2.95). However, the rate of microbiology testing was not comparably higher among them (with asthma aIRR:1.03,
95%CI:1.00–1.05; with COPD aIRR:1.00, 95%CI:0.94–1.06).
Conclusions: Priority antibiotics with high resistance risk are commonly dispensed among community-dwelling
older adults. The discord between the rate of microbiology testing and antibiotic dispensing in adults with chronic
respiratory diseases suggests the potential for excessive empirical prescribing.
Description
Keywords
Watch group antibiotics, Microbiology testing, Community, Stewardship
Citation
Collections
Source
BMC Infectious Diseases
Type
Journal article
Book Title
Entity type
Access Statement
Open Access
License Rights
Creative Commons Attribution 4.0 International License
DOI
10.1186/s12879-020-05029-z