Antibiotic overuse for never-appropriate acute respiratory tract infections among older adults presenting to United States emergency departments, 2013-2025: Interrupted time series analysis across national stewardship milestones.

IF 2.6 3区医学 Q2 INFECTIOUS DISEASES

American journal of infection control Pub Date : 2026-07-31 DOI:10.1016/j.ajic.2026.07.013

Mayar Al Mohajer, Kasim Allel, David Slusky, David E Nix, Catia Nicodemo

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引用次数: 0

Abstract

Background: Antibiotic overuse for acute respiratory tract infections (ARTIs) remains common in emergency departments (EDs), but national trends among older adults are not well described.

Methods: We conducted a retrospective cohort study of US ED encounters in Epic Cosmos (January 2013-December 2025) among adults aged 65 years or older with never-appropriate ARTI diagnoses. Monthly antibiotic overuse (ED administration and/or discharge prescription) was evaluated with segmented regression around Centers for Disease Control and Prevention (CDC) Core Elements (November 2016), The Joint Commission (TJC) ambulatory stewardship standard (January 2020), COVID-19 onset (March 2020), and Centers for Medicare & Medicaid Services (CMS) interpretive guidance (July 2022).

Results: Among 838,929 encounters, antibiotic overuse occurred in 38.5%. In the primary model, estimated 12-month changes were -5.0 percentage points (95% CI, -7.1 to -3.0; P < .001) around the CDC milestone and -15.7 percentage points (95% CI, -31.3 to -0.1; P = .049) around TJC. Estimates around COVID-19 and CMS were less stable.

Discussion: Declines were most consistent around the CDC milestone; later estimates were limited by closely spaced interruptions and pandemic disruption.

Conclusions: ED-focused outpatient stewardship remains needed for older adults with never-appropriate ARTIs.

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2013-2025年在美国急诊科就诊的老年人中过度使用抗生素治疗不适当的急性呼吸道感染：跨国家管理里程碑的中断时间序列分析

背景：急性呼吸道感染（ARTIs）的抗生素过度使用在急诊科（EDs）仍然很常见，但老年人的全国趋势尚未得到很好的描述。方法：我们对Epic Cosmos（2013年1月- 2025年12月）中65岁及以上未确诊ARTI的成年人进行了一项回顾性队列研究。每月抗生素过度使用（ED给药和/或出院处方）采用分段回归评估，围绕疾病控制和预防中心（CDC）核心要素（2016年11月）、联合委员会（TJC）门诊管理标准（2020年1月）、COVID-19发病（2020年3月）和医疗保险和医疗补助服务中心（CMS）解释性指南（2022年7月）。结果：838,929例就诊中，抗生素过度使用发生率为38.5%。在主要模型中，估计12个月的变化为-5.0个百分点（95% CI, -7.1至-3.0）；P讨论：下降在CDC里程碑周围最一致；后期估计受到间隔紧密的中断和大流行中断的限制。结论：对于患有不合适ARTIs的老年人，仍然需要以ed为重点的门诊管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of infection control 医学-传染病学

CiteScore

7.40

自引率

4.10%

发文量

479

审稿时长

24 days

期刊介绍： AJIC covers key topics and issues in infection control and epidemiology. Infection control professionals, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC)