Identifying Patterns of Primary Care Antibiotic Prescribing for a Spinal Cord Injury (SCI) Cohort Using an Electronic Medical Records (EMR) Database

Top Spinal Cord Inj Rehabil, 2023 · DOI: 10.46292/sci23-00047S · Published: January 1, 2023

Spinal Cord Injury Immunology Healthcare

Simple Explanation

Individuals with spinal cord injuries (SCI) often experience recurrent infections, leading to frequent antibiotic use. This can contribute to antimicrobial resistance (AMR), where bacteria become less responsive to antibiotics. This study examines antibiotic prescribing patterns in primary care for adults with SCI, focusing on the types of antibiotics prescribed, the reasons for prescriptions, and the duration of treatment. The study found that urinary tract infections (UTIs) were the most common reason for antibiotic prescriptions, and fluoroquinolones were the most frequently prescribed antibiotic class. Catheter use was associated with increased antibiotic prescriptions, and physicians with longer careers tended to prescribe antibiotics for longer durations.

Study Duration

3 Years

Participants

432 adults with SCI

Evidence Level

Retrospective cohort study

Key Findings

1
UTIs were the most common indication for antibiotic prescription, accounting for 59.8% of prescriptions.
2
Fluoroquinolones were the most frequently prescribed antibiotic class, representing 24.6% of all prescriptions.
3
Catheter use was significantly associated with an increased number of antibiotics prescribed (RR = 3.1; 95% CI, 2.3-4.1; p < .001).

Research Summary

This study investigated primary care antibiotic prescribing patterns for adults with SCI using linked health administrative and electronic medical records databases from 2013 to 2015. The study found that UTIs were the most common indication for antibiotic prescriptions, and fluoroquinolones were the most frequently prescribed antibiotic class. Catheter use was associated with an increased number of antibiotics prescribed, while late-career PCPs tended to prescribe antibiotics for longer durations compared to early-career PCPs.

Practical Implications

Targeted Interventions

Focus antibiotic prescribing optimization interventions on individuals with SCI who are frequent antibiotic users to mitigate the risk of multidrug-resistant bacteria.

Judicious Prescribing

Encourage PCPs to judiciously prescribe antibiotics, ensuring the right dose, duration, and antibiotic class are prescribed for specific infections to minimize AMR.

Guideline Adherence

Promote adherence to guidelines recommending the shortest clinically safe antibiotic duration and narrow-spectrum antibiotics over broad-spectrum antibiotics, where possible, for individuals with SCI.

Study Limitations

1
Missing patient injury characteristics, antibiotic prescribing indications, and duration information in some cases.
2
Inconsistent level of detail regarding severity of injury, antibiotic indication, and impairments across patient charts.
3
Unclear if individuals consumed the antibiotics they were prescribed.

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