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Childhood obesity continues to be a significant public health concern, and metabolic and bariatric surgery (MBS) is a contemporary intervention that remains underutilized. Records from the Kids' Inpatient Database (KID) were analyzed from 2009 to 2016 were analyzed to evaluate utilization characteristics of pediatric MBS. Annual procedure rates increased from 2.98 to 4.94 per 100,000 US adolescents. White children received the highest proportion of MBS at all time points; however, significant increases were seen among Black and Hispanic children. Despite these increases, a disproportionate racial bias persists indicating a need for further provider education and research into the utilization gap for minority patients. [ABSTRACT FROM AUTHOR]

Purpose: To characterize antibiotic utilization for outpatient community‐acquired pneumonia (CAP) in the United States. Methods: We conducted a cohort study among adults 18–64 years diagnosed with outpatient CAP and a same‐day guideline‐recommended oral antibiotic fill in the MarketScan® Commercial Database (2008–2019). We excluded patients coded for chronic lung disease or immunosuppressive disease; recent hospitalization or frequent healthcare exposure (e.g., home wound care, patients with cancer); recent antibiotics; or recent infection. We characterized utilization of broad‐spectrum antibiotics (respiratory fluoroquinolone, β‐lactam + macrolide, β‐lactam + doxycycline) versus narrow‐spectrum antibiotics (macrolide, doxycycline) overall and by patient‐ and provider‐level characteristics. Per 2007 IDSA/ATS guidelines, we stratified analyses by otherwise healthy patients and patients with comorbidities (coded for diabetes; chronic heart, liver, or renal disease; etc.). Results: Among 263 914 otherwise healthy CAP patients, 35% received broad‐spectrum antibiotics (not recommended); among 37 161 CAP patients with comorbidities, 44% received broad‐spectrum antibiotics (recommended). Ten‐day antibiotic treatment durations were the most common for all antibiotic classes except macrolides. From 2008 to 2019, broad‐spectrum antibiotic use substantially decreased from 45% to 19% in otherwise healthy patients (average annual percentage change [AAPC], −7.5% [95% CI −9.2%, −5.9%]), and from 55% to 29% in patients with comorbidities (AAPC, −5.8% [95% CI −8.8%, −2.6%]). In subgroup analyses, broad‐spectrum antibiotic use varied by age, geographic region, provider specialty, and provider location. Conclusions: Real‐world use of broad‐spectrum antibiotics for outpatient CAP declined over time but remained common, irrespective of comorbidity status. Prolonged duration of therapy was common. Antimicrobial stewardship is needed to aid selection according to comorbidity status and to promote shorter courses. [ABSTRACT FROM AUTHOR]

Background Ceftriaxone is a convenient option for methicillin-sensitive Staphylococcus aureus (MSSA) outpatient parenteral antimicrobial therapy (OPAT), but population-based studies for its effectiveness are lacking. Methods In this retrospective cohort, a large insurance claims database was queried from 2010 to 2018 for adults with MSSA bloodstream infection (BSI). Patients discharged on OPAT on cefazolin or oxacillin/nafcillin were compared with ceftriaxone with respect to 90-day hospital readmission with the same infection category and 90-day all-cause readmission using logistic regression models. Results Of 1895 patients with MSSA BSI, 1435 (75.7%) patients received cefazolin, oxacillin, or nafcillin and 460 (24.3%) ceftriaxone. Readmission due to the same infection category occurred in 366 (19.3%), and all-cause readmission occurred in 535 (28.3%) within 90 days. Risk factors significantly associated with readmission with the same infection category were the oldest sampled age group (61–64 years: adjusted odds ratio [aOR], 1.47 [95% confidence interval {CI}, 1.01–2.14]), intensive care unit stay during index admission (aOR, 2.33 [95% CI, 1.81–3.01]), prosthetic joint infection (aOR, 1.96 [95% CI, 1.18–2.23]), central line–associated BSI (aOR, 1.72 [95% CI, 1.33–2.94]), and endocarditis (aOR, 1.63 [95% CI, 1.18–2.23]). Ceftriaxone was not associated with increased risk of readmission with the same infection category (aOR, 0.89 [95% CI,.67–1.18]), or 90-day all-cause readmission (aOR, 0.86 [95% CI,.66–1.10]) when compared with oxacillin/nafcillin/cefazolin. Conclusions In this cohort of MSSA BSI patients discharged on OPAT, there were no differences in outcomes of readmission with the same infection and 90-day all-cause readmission in patients treated with ceftriaxone compared to oxacillin/nafcillin or cefazolin. Patients with complicated BSIs such as endocarditis and epidural abscess were more likely to be prescribed cefazolin or oxacillin/nafcillin. [ABSTRACT FROM AUTHOR]

Background Little is known about the clinical and financial consequences of inappropriate antibiotics. We aimed to estimate the comparative risk of adverse drug events and attributable healthcare expenditures associated with inappropriate versus appropriate antibiotic prescriptions for common respiratory infections. Methods We established a cohort of adults aged 18 to 64 years with an outpatient diagnosis of a bacterial (pharyngitis, sinusitis) or viral respiratory infection (influenza, viral upper respiratory infection, nonsuppurative otitis media, bronchitis) from 1 April 2016 to 30 September 2018 using Merative MarketScan Commercial Database. The exposure was an inappropriate versus appropriate oral antibiotic (ie, non-guideline-recommended vs guideline-recommended antibiotic for bacterial infections; any vs no antibiotic for viral infections). Propensity score-weighted Cox proportional hazards models were used to estimate the association between inappropriate antibiotics and adverse drug events. Two-part models were used to calculate 30-day all-cause attributable healthcare expenditures by infection type. Results Among 3 294 598 eligible adults, 43% to 56% received inappropriate antibiotics for bacterial and 7% to 66% for viral infections. Inappropriate antibiotics were associated with increased risk of several adverse drug events, including Clostridioides difficile infection and nausea/vomiting/abdominal pain (hazard ratio, 2.90; 95% confidence interval, 1.31–6.41 and hazard ratio, 1.10; 95% confidence interval, 1.03–1.18, respectively, for pharyngitis). Thirty-day attributable healthcare expenditures were higher among adults who received inappropriate antibiotics for bacterial infections ($18–$67) and variable (−$53 to $49) for viral infections. Conclusions Inappropriate antibiotic prescriptions for respiratory infections were associated with increased risks of patient harm and higher healthcare expenditures, justifying a further call to action to implement outpatient antibiotic stewardship programs. [ABSTRACT FROM AUTHOR]