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Hospital-based antibiotic use in patients with Mycobacterium avium complex
Treatment guidelines exist for pulmonary Mycobacterium avium complex (MAC) infection, although studies suggest poor concordance in clinician practice. Using a national database including hospital encounters of laboratory-confirmed MAC patients, we sought to characterise US treatment practices. We as...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
European Respiratory Society
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213287/ https://www.ncbi.nlm.nih.gov/pubmed/30402451 http://dx.doi.org/10.1183/23120541.00109-2018 |
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author | Ricotta, Emily E. Olivier, Kenneth N. Lai, Yi Ling Prevots, D. Rebecca Adjemian, Jennifer |
author_facet | Ricotta, Emily E. Olivier, Kenneth N. Lai, Yi Ling Prevots, D. Rebecca Adjemian, Jennifer |
author_sort | Ricotta, Emily E. |
collection | PubMed |
description | Treatment guidelines exist for pulmonary Mycobacterium avium complex (MAC) infection, although studies suggest poor concordance in clinician practice. Using a national database including hospital encounters of laboratory-confirmed MAC patients, we sought to characterise US treatment practices. We assessed patients in the Premier Healthcare Database from 2009 to 2013 with two or more MAC-positive cultures or one MAC-positive culture and the International Classification of Diseases (9th revision) code for pulmonary nontuberculous mycobacteria (PNTM). Treatment was characterised by patient-, provider- and facility-level factors; significant differences were assessed (p<0.05). Multilevel Poisson regression estimated adjusted relative risks (aRR) of receiving guidelines-based or macrolide resistance-promoting regimens. Of 1326 MAC patients, 645 (49%) received treatment: 10% received guidelines-based treatment and 18% resistance-associated therapy. Patients were more likely to receive guidelines-based therapy if they had multiple hospital encounters (aRR 1.5), codes for PNTM (aRR 5.7) or tuberculosis (aRR 4.5) or radiological procedures (aRR 10.9); multiple hospital encounters (aRR 0.8) or a tuberculosis code (aRR 0.1) were less likely to be associated with receiving resistance-promoting regimens. In hospital-based MAC patients, half received antibiotics active against MAC, a low proportion received therapy based on MAC guidelines and many received antibiotics that promote macrolide resistance. Improved implementation of guidelines-based treatment is needed to decrease use of regimens associated with macrolide resistance. |
format | Online Article Text |
id | pubmed-6213287 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | European Respiratory Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-62132872018-11-06 Hospital-based antibiotic use in patients with Mycobacterium avium complex Ricotta, Emily E. Olivier, Kenneth N. Lai, Yi Ling Prevots, D. Rebecca Adjemian, Jennifer ERJ Open Res Original Articles Treatment guidelines exist for pulmonary Mycobacterium avium complex (MAC) infection, although studies suggest poor concordance in clinician practice. Using a national database including hospital encounters of laboratory-confirmed MAC patients, we sought to characterise US treatment practices. We assessed patients in the Premier Healthcare Database from 2009 to 2013 with two or more MAC-positive cultures or one MAC-positive culture and the International Classification of Diseases (9th revision) code for pulmonary nontuberculous mycobacteria (PNTM). Treatment was characterised by patient-, provider- and facility-level factors; significant differences were assessed (p<0.05). Multilevel Poisson regression estimated adjusted relative risks (aRR) of receiving guidelines-based or macrolide resistance-promoting regimens. Of 1326 MAC patients, 645 (49%) received treatment: 10% received guidelines-based treatment and 18% resistance-associated therapy. Patients were more likely to receive guidelines-based therapy if they had multiple hospital encounters (aRR 1.5), codes for PNTM (aRR 5.7) or tuberculosis (aRR 4.5) or radiological procedures (aRR 10.9); multiple hospital encounters (aRR 0.8) or a tuberculosis code (aRR 0.1) were less likely to be associated with receiving resistance-promoting regimens. In hospital-based MAC patients, half received antibiotics active against MAC, a low proportion received therapy based on MAC guidelines and many received antibiotics that promote macrolide resistance. Improved implementation of guidelines-based treatment is needed to decrease use of regimens associated with macrolide resistance. European Respiratory Society 2018-11-02 /pmc/articles/PMC6213287/ /pubmed/30402451 http://dx.doi.org/10.1183/23120541.00109-2018 Text en The content of this work is not subject to copyright. Design and branding are ©ERS 2018 http://creativecommons.org/licenses/by-nc/4.0/ This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. |
spellingShingle | Original Articles Ricotta, Emily E. Olivier, Kenneth N. Lai, Yi Ling Prevots, D. Rebecca Adjemian, Jennifer Hospital-based antibiotic use in patients with Mycobacterium avium complex |
title | Hospital-based antibiotic use in patients with Mycobacterium avium complex |
title_full | Hospital-based antibiotic use in patients with Mycobacterium avium complex |
title_fullStr | Hospital-based antibiotic use in patients with Mycobacterium avium complex |
title_full_unstemmed | Hospital-based antibiotic use in patients with Mycobacterium avium complex |
title_short | Hospital-based antibiotic use in patients with Mycobacterium avium complex |
title_sort | hospital-based antibiotic use in patients with mycobacterium avium complex |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213287/ https://www.ncbi.nlm.nih.gov/pubmed/30402451 http://dx.doi.org/10.1183/23120541.00109-2018 |
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