691. Antibiotic Use Metrics to Guide Antibiotic Stewardship Priorities: Dental Antibiotic Prescribing in the U.S. Veterans Affairs (VA) System
Session: Poster Abstract Session: Stewardship: Data and Program Planning
Thursday, October 5, 2017
Room: Poster Hall CD
  • Suda-2013 Abx Metrics Poster-final.pdf (832.4 kB)
  • Background: In the private sector, dentists prescribe approximately 1 out of every 10 antibiotic prescriptions and are the top specialty prescriber of antibiotics. However, antibiotic prescribing practices of VA dentists have not been reported. Standardized metrics of antibiotic consumption (ie, antibiotic days) are useful to guide stewardship efforts, but have not been reported for dentistry. Thus, the purpose of this study is to report antibiotic use metrics in the VA with an emphasis on antibiotics prescribed by dentists.

    Methods: Cross-sectional study of all Veteran users of VA dental care from all dental clinics (n=205) in 2013. Antibiotic data were collected at the patient-level where >1 day and/or >1 dose of a systemic antibiotic was ordered and dispensed. Metrics included: antibiotic days (AD; average number of days/patient where any antibiotic was administered) and days of therapy (DOT; average number of days/patient where a unique agent was administered). Dentists were identified by VA personnel files with the professional designation of ‘Dentistry.’ Antibiotics in the carbapenem, quinolone, anti-pseudomonal penicillin, 3rd/4th generation cephalosporin, macrolide, tetracycline, and aminoglycoside classes were considered to be broad spectrum. Student’s t-test was used for statistical analysis; p<0.05 was considered significant.

    Results: In 2013, >1 antibiotic dose/day was prescribed to 16.2% of VA dental patients (total=476,451 patients). By class, aminopenicillins were most frequently prescribed (69.4%), followed by lincomycins (21.9%). The overall mean AD was 11.4 (range=1-309) days and DOT was 11.5 (1-309). Of the Veterans who received an antibiotic from a dentist, only 2.3% received a broad spectrum agent. However, broad spectrum AD (15.0) was significantly longer than narrow spectrum AD (11.2; p<0.0001).

    Conclusion: While the prevalence of broad spectrum prescribing was low, the patient-level duration of antibiotics prescribed by VA dentists is surprising. Thus, there may be an opportunity to expand antimicrobial stewardship efforts to dental providers.

    Kj Suda, PharmD, M.S., University of Illinois at Chicago, Chicago, IL, Margaret Fitzpatrick, MD, M.S., VA Center of Innovation for Complex Chronic Healthcare, Hines, IL, Gretchen Gibson, DDS, MPH, Veterans Health Care System of the Ozarks, Fayetteville, AR, Marianne Jurasic, DMD, MPH, Boston VA Hospital, Boston, MA, Scott Miskevics, MS, Hines VA Hospital, Hines, IL, Jessina C. McGregor, PhD, Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, OR, Swetha Ramanathan, MPH, Center for Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL and Charlesnika Evans, PhD, MPH, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL


    K. Suda, None

    M. Fitzpatrick, None

    G. Gibson, None

    M. Jurasic, None

    S. Miskevics, None

    J. C. McGregor, Merck & Co.: Grant Investigator , Research grant

    S. Ramanathan, None

    C. Evans, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.