Outpatient Antibiotic Prescribing Patterns for Adult End-Stage Renal Disease Patients in New York State

Abstract

Background: Infections are important complications of end-stage renal disease (ESRD) with few studies having investigated oral antibiotic use. Inappropriate antibiotic prescribing can contribute to multidrug-resistant organisms and Clostridioides difficile infections seen in ESRD. This study investigates antibiotic prescribing practices in ESRD across New York State (NYS).

Methods: Retrospective case-control study from 2016 to 2017 of NYS ESRD and non-ESRD patients analyzing Medicare part B billing codes, 7 days before and 3 days after part D claims. Frequencies of each infection, each antibiotic, dosages, and the antibiotics associated with infections were assessed using χ 2 analysis. A NYS small dialysis organization comprising approximately 2200 patients was also analyzed. Outcomes measured were the frequencies of infections and of each antibiotic prescribed. Incidence measures included antibiotics per 1000 and individuals receiving antibiotics per 1000.

Results: A total of 48 100 infections were treated in 35 369 ESRD patients and 2 544 443 infections treated in 3 777 314 non-ESRD patients. ESRD patients were younger, male, and African American. ESRD and non-ESRD patients receiving antibiotics was 520.29/1000 and 296.48/1000, respectively (P < .05). The prescription incidence was 1359.95/1000 ESRD vs 673.61/1000 non-ESRD patients. In 36%, trimethoprim-sulfamethoxazole dosage was elevated by current ESRD guidelines. Top infectious categories included nonspecific symptoms, skin, and respiratory for ESRD; and respiratory, nonspecific symptoms, and genitourinary in non-ESRD.

Conclusions: This study identifies issues with appropriate antibiotic usage stressing the importance of antibiotic education to nephrologist and nonnephrologist providers. It provides support for outpatient antibiotic stewardship programs.

Keywords: ESRD; antibiotic stewardship; hemodialysis; oral antibiotics.