1244. Evaluation of Antibiotic Prescribing Practices for Geriatric Patients in the Outpatient Setting in a Veterans Affairs Hospital: Identification of Stewardship Targets
Session: Poster Abstract Session: Healthcare Epidemiology: Non-acute Care Settings
Friday, October 5, 2018
Room: S Poster Hall
  • Geriatric stewardship baw.pdf (594.1 kB)
  • Background:

    Antibiotics are frequently overused in the outpatient setting, however it is unknown how antibiotic use differs with age. Infections are a leading cause of hospitalization in elderly patients. Prescribing appropriateness for patients less than (<) 65 years old was compared to patients at or above (>/=) 65 years old in order to identify targets for antimicrobial stewardship in this population.


    A retrospective review of all outpatient antibiotic prescriptions between June and September of 2017. Prescriptions were reviewed based on alerts in the electronic medical record when orders for antibiotics were signed by the provider. Appropriateness of antibiotics was assessed based on clinical practice guidelines. Retreatment and hospital admissions were documented. Those aged < 65 were compared to those greater than or >/= 65 years of age using Student’s t-test and Chi-squared tests. A multivariate logistic regression model was constructed to identify risk factors for inappropriate use of antibiotics between the two age groups.


    The study period yielded 1700 prescriptions after exclusions 1063 were included in the analysis. Patients >/= 65 comprised 51% of the population. Older patients had significantly more comorbidities than the younger population. No significant difference was observed for antibiotic indicated (60%), correct drug (50%), or correct duration (75%) between the two age groups. Patients in the >/= 65 cohort were statistically significantly more likely to receive an inappropriate dose (86% vs. 76%, p<0.002). In the multivariable analysis, patients with COPD were more likely to be appropriately with antibiotics OR 1.4 (95%CI: 1.03-1.9) compared to those without COPD. Older patients were not more likely to be retreated or admitted for the same indication within 30 days.


    Antibiotics were frequently overused in the outpatient setting, however they were not more frequently used in elderly patients. However, older adults were more likely to be prescribed an antibiotic at an inappropriate dose highlighting the need for increased caution with dosage selection in this population. Stewardship teams caring for elderly patients should be cognizant of dosing in this population.

    Collin Clark, PharmD1, Alexis White, PharmD1, John Sellick, D.O., M.S., FIDSA, FSHEA2 and Kari Mergenhagen, Pharm.D., BCPS AQ-ID3, (1)Pharmacy, VA WNY Healthcare System, Buffalo, NY, (2)Department of Medicine, VA Western New York Healthcare System, Buffalo, NY, (3)Department of Infectious Diseases, VA Western New York Healthcare System, Buffalo, NY


    C. Clark, None

    A. White, None

    J. Sellick, None

    K. Mergenhagen, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.