77. Antimicrobial Prescribing Practices for Enteric Bacterial Infections in an Integrated Rural Healthcare System, 2004–2017

Abstract

BackgroundBacterial enteric infections are common in the United States, but few studies have evaluated antibiotic prescribing practices for these illnesses. Unnecessary antibiotics can lead to adverse events and emergence of antimicrobial resistance. We assessed treatment practices among patients with laboratory-confirmed enteric infections in a large regional healthcare system.MethodsWe used electronic health records to identify patients with laboratory-confirmed nontyphoidal Salmonella, Shigella, Shiga toxin-producing E. coli (STEC), and Campylobacter infections from 2004 to 2017. We extracted relevant clinical data, including diagnosis codes for chronic conditions and receipt of immunosuppressive medications in the 60 days before and after the encounter, and antibiotic prescriptions in the 14 days after the encounter. We defined an appropriate treatment based on pathogen, patient characteristics, and IDSA practice guidelines for the study period.ResultsWe identified 2,064 patients infected with enteric pathogens: 1,251 (61%) with Campylobacter, 564 (27%) Salmonella, 199 (10%) STEC, and 50 (2%) Shigella. Overall, 425 (20%) patients were immunocompromised, ranging from 17% for Salmonella to 46% for STEC. There were 220 (11%) hospitalizations. The frequency of antibiotic prescribing was highest for Campylobacter (60%), followed by Shigella (50%) and Salmonella (49%). Prescriptions were appropriate for 62% of Campylobacter cases, 92% of Shigella, and 70% of Salmonella. Antibiotics were prescribed for 39% of STEC infections although they are generally not indicated. Appropriate treatment was highest for children with Campylobacter (87%) and lowest for adults ≥50 years with Campylobacter (42%). Among those with Salmonella, appropriate treatment was higher in those with a comorbidity (79% vs. 68% without, P < 0.05). Rates of appropriate use did not improve over time.ConclusionAntibiotic prescribing for laboratory-confirmed enteric infections was frequently inappropriate and inconsistent with practice guidelines. Antibiotic stewardship initiatives should address acute bacterial gastrointestinal infections in addition to other common infections.Disclosures All Authors: No reported Disclosures.