Abstract
Background
The rise of antibiotic-resistant pathogens is believed to have influenced the emergency
department (ED) epidemiology and management of infectious diseases (IDs) since 2000.
Methods
Data from the National Hospital Ambulatory Medical Care Survey from 2000 to 2010 were
used to examine temporal trends in the incidence of IDs presenting to EDs. Outcome
measures included national visit rates, visit proportions, and antimicrobial prescriptions
for all ID primary diagnoses, as well as for specific organ systems of interest (respiratory
tract, skin/soft tissue, and urinary tract).
Results
An ID-related primary diagnosis was given in 18.3% (95% confidence interval, 17.9%-18.8%)
of all ED visits during the study period. The hospitalization rate for these conditions
is 7.8% (95% confidence interval, 7.3%-8.3%). The share of macrolide prescriptions
for upper respiratory tract infections and lower respiratory tract infections increased
by 34% and 46%, respectively, and that of quinolone prescription for lower respiratory
tract infections doubled from 9% to 18.4% during the study period. Management of skin
and soft tissue infections shifted from predominant use of cephalosporins to sulfonamides.
For UTIs, quinolones were most commonly prescribed, with an increasing use of third-generation
cephalosporins. Antibiotics were more frequently prescribed to patients who are white
compared with (white: 60%, black: 57%, other races: 52%, P < .05).
Conclusion
The changing epidemiology of IDs diagnosed in US EDs reflects national trends in emerging
pathogens and drug resistance. Broad-spectrum antibiotics are being prescribed at
increasing rates. There are significant demographic disparities in nationwide antibiotic
prescription practices.
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Article Info
Publication History
Published online: March 11, 2016
Accepted:
March 7,
2016
Received in revised form:
March 7,
2016
Received:
November 19,
2015
Footnotes
☆Authors' contributions: Y-HH designed the study. Y-HH performed data analyses. Y-HH, AMM, and AFD interpreted results. YH-H primarily designed tables and figures. AMM primarily drafted the manuscript. Y-HH and AFD assisted with literature review and critical editing of the manuscript.
Identification
Copyright
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