966. A Closer Look at Antibiotic Prescribing for Upper Respiratory Illnesses (URI) in People with HIV Compared with People Without HIV

Abstract

BackgroundAntibiotic overuse is widespread, increasing healthcare cost and promoting antimicrobial resistance. People with HIV (PWH) who develop URIs may be assumed “higher risk,” compared with non-PWH, but comparative antibiotic use evaluations have not been performed. We evaluated antibiotic prescribing patterns for URI diagnoses (cough, sinusitis, bronchitis, and cold) in PWH and non-PWH.MethodsThis was an observational, single-center study comparing PWH and non-PWH diagnosed with URI (using ICD 10 codes for URI syndromes: cough, sinusitis, bronchitis, and cold) between January 1, 2014 and April 30, 2018. Patients were empaneled in an outpatient primary care clinic or specialty care clinic in one healthcare system. Appropriateness of antibiotic prescribing was defined based on published guidelines. Fisher’s exact test compared categorical variables with antibiotic prescribing patterns. Each encounter was considered an independent event.ResultsThe two groups (PWH and non-PWH) were similar, with 34% of subjects in both groups being female. PWH had median CD4+ count of 610 cells/mm3 with 91% on antiretrovirals and 77% with HIV RNA < 20 copies/mL. Overall, 37% of visits resulted in antibiotic prescriptions, 92% of which were inappropriate (discordant with guidelines). Antibiotics were prescribed slightly more frequently in non-PWH (40% vs. 33%, P = 0.056; Figure 1) and inappropriate more often in non-PWH (37% vs. 30%, P = 0.029). Over 20% of PWH antibiotic prescriptions were too long, and 22% of non-PWH received the wrong drug (Figure 2; P = 0.011). 47% of the non-PWH receiving antibiotics for URI had private insurance (compared with other payers; P < 0.0001) vs. 33% in PWH (P = 0.32) (Figure 3).ConclusionOutpatient antibiotic overuse remains prevalent among patients evaluated for URIs. This is the first study, to our knowledge, comparing antibiotic use for URIs in PWH compared with non-PWH. Counterintuitively, we found less-frequent inappropriate antibiotic use in PWH. We speculate that PWH are more likely to be evaluated by infectious disease/HIV specialists, possibly explaining the lower rate of antibiotic prescriptions for URIs in this population. Future analyses will evaluate the association between provider specialty and inappropriate antibiotic use. Disclosures All Authors: No reported Disclosures.