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Antibiotic Prescribing Practice in the Emergency Room for Veterans with Spinal Cord Injury and Disorder

Evans CT, Smith BM, Chin A, Miskevics SA, Burns SP, Weaver FM. Antibiotic Prescribing Practice in the Emergency Room for Veterans with Spinal Cord Injury and Disorder. Poster session presented at: VA QUERI National Meeting; 2008 Dec 12; Phoenix, AZ.


Objectives: Clinical guidelines exist to promote antibiotic stewardship, particularly in ambulatory care settings such as in emergency rooms (ER). However, there is limited evidence on prescribing practice for persons with spinal cord injury and disorder (SCI/D). The goal of this study was to assess trends in antibiotic prescribing in the ER setting for persons with SCIandD. Methods: This was a retrospective dynamic cohort design including all ER visits for veterans with SCIandD that did not result in same day hospitalization over six years (FY2002-FY2007). VA medical and administrative databases were used to identify the cohort, demographics, diagnoses, pharmacy data, and facility type. The rate of antibiotic prescribing for ER visits was defined as the number of antibiotics/total ER visits. Multivariable random-effect regression modeling was used to assess trends and other factors associated with prescribing. Results: There were 52,077 ER visits and 12,802 antibiotics prescribed over the study period (rate of 245.8 prescriptions/1000 visits). The antibiotic prescribing rate increased from 220.2/1000 visits in FY2002 to 296.2/1000 visits in FY2007 (p < 0.0001). This increase in the rate of prescribing was seen across all patient demographics and factors assessed. Of note, the highest rates of prescribing in FY2007 were seen for the age group < 50 years (319.2/1000 visits), those with complete SCI (392.0/1000 visits), those injured for 20+ years (360.9/1000 visits), those with a traumatic injury (347.7/1000 visits), having an upper respiratory infection (575.8/1000 visits), and having a lower respiratory infection (881.4/1000 visits). Implications: Although clinical guidelines for judicious use of antibiotics have been disseminated in persons with SCIandD, the rate of antibiotic prescribing in an ER setting is high and is continuing to rise in this population. Impacts: Increases in antibiotic resistant strains of various infections and continued over-prescribing of antimicrobials affect incidence, severity, and management of infections. This is of particular importance for persons with SCIandD, who typically have increased antibiotic use for treatment of numerous infections including urinary tract and pressure ulcer infections. Next steps include identifying appropriate implementation strategies to promote judicious use of antibiotics.

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