{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T15:33:02Z","timestamp":1776439982217,"version":"3.51.2"},"reference-count":25,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2017,12,28]],"date-time":"2017-12-28T00:00:00Z","timestamp":1514419200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec id=\"S0899823X17002501_abs1\" sec-type=\"general\"><jats:title>OBJECTIVE<\/jats:title><jats:p>The optimal approach to auditing outpatient antimicrobial prescribing has not been established. We assessed how different types of electronic data\u2014including prescriptions, patient-visits, and <jats:italic>International Classification of Disease, Tenth Revision<\/jats:italic> (ICD-10) codes\u2014could inform automated antimicrobial audits.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X17002501_abs2\" sec-type=\"general\"><jats:title>DESIGN<\/jats:title><jats:p>Outpatient visits during 2016 were retrospectively reviewed, including chart abstraction, if an antimicrobial was prescribed (cohort 1) or if the visit was associated with an infection-related ICD-10 code (cohort 2). Findings from cohorts 1 and 2 were compared.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X17002501_abs3\" sec-type=\"general\"><jats:title>SETTING<\/jats:title><jats:p>Primary care clinics and the emergency department (ED) at the Iowa City Veterans Affairs Medical Center.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X17002501_abs4\" sec-type=\"results\"><jats:title>RESULTS<\/jats:title><jats:p>In cohort 1, we reviewed 2,353 antimicrobial prescriptions across 52 providers. ICD-10 codes had limited sensitivity and positive predictive value (PPV) for validated cases of cystitis and pneumonia (sensitivity, 65.8%, 56.3%, respectively; PPV, 74.4%, 52.5%, respectively). The volume-adjusted antimicrobial prescribing rate was 13.6 per 100 ED visits and 7.5 per 100 primary care visits. In cohort 2, antimicrobials were not indicated in 474 of 851 visits (55.7%). The antimicrobial overtreatment rate was 48.8% for the ED and 59.7% for primary care. At the level of the individual prescriber, there was a positive correlation between a provider\u2019s volume-adjusted antimicrobial prescribing rate and the individualized rates of overtreatment in both the ED (r=0.72; <jats:italic>P<\/jats:italic>&lt;.01) and the primary care setting (r=0.82; <jats:italic>P<\/jats:italic>=0.03).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X17002501_abs5\" sec-type=\"conclusions\"><jats:title>CONCLUSIONS<\/jats:title><jats:p>In this single-center study, ICD-10 codes had limited sensitivity and PPV for 2 infections that typically require antimicrobials. Electronically extracted data on a provider\u2019s rate of volume-adjusted antimicrobial prescribing correlated with the frequency at which unnecessary antimicrobials were prescribed, but this may have been driven by outlier prescribers.<\/jats:p><jats:p><jats:italic>Infect Control Hosp Epidemiol<\/jats:italic> 2018;39:64\u201370<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2017.250","type":"journal-article","created":{"date-parts":[[2017,12,28]],"date-time":"2017-12-28T10:18:00Z","timestamp":1514456280000},"page":"64-70","source":"Crossref","is-referenced-by-count":11,"title":["The Value of Electronically Extracted Data for Auditing Outpatient Antimicrobial Prescribing"],"prefix":"10.1017","volume":"39","author":[{"given":"Daniel J.","family":"Livorsi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carrie M.","family":"Linn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce","family":"Alexander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett H.","family":"Heintz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Traviss A.","family":"Tubbs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eli N.","family":"Perencevich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2017,12,28]]},"reference":[{"key":"S0899823X17002501_ref5","first-page":"1","article-title":"Core elements of outpatient antibiotic stewardship","volume":"65","author":"Sanchez","year":"2016","journal-title":"MMWR"},{"key":"S0899823X17002501_ref7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1406330"},{"key":"S0899823X17002501_ref18","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0275"},{"key":"S0899823X17002501_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/S1553-7250(08)34086-0"},{"key":"S0899823X17002501_ref17","doi-asserted-by":"publisher","DOI":"10.1086\/677826"},{"key":"S0899823X17002501_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(14)70952-1"},{"key":"S0899823X17002501_ref3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.4151"},{"key":"S0899823X17002501_ref4","unstructured":"The White House. National Action Plan for Combating Antibiotic-Resistant Bacteria.Washington, DC; 2015."},{"key":"S0899823X17002501_ref23","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofw168"},{"key":"S0899823X17002501_ref13","doi-asserted-by":"publisher","DOI":"10.1177\/1062860605280358"},{"key":"S0899823X17002501_ref1","doi-asserted-by":"publisher","DOI":"10.1177\/2042098614554919"},{"key":"S0899823X17002501_ref6","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2017.59"},{"key":"S0899823X17002501_ref8","doi-asserted-by":"publisher","DOI":"10.7326\/M15-1840"},{"key":"S0899823X17002501_ref10","doi-asserted-by":"publisher","DOI":"10.1086\/511159"},{"key":"S0899823X17002501_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2013.02.005"},{"key":"S0899823X17002501_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2006.10.018"},{"key":"S0899823X17002501_ref22","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkt301"},{"key":"S0899823X17002501_ref15","doi-asserted-by":"publisher","DOI":"10.1186\/cc6969"},{"key":"S0899823X17002501_ref16","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit737"},{"key":"S0899823X17002501_ref19","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.14191"},{"key":"S0899823X17002501_ref25","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2015.113"},{"key":"S0899823X17002501_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00215-4"},{"key":"S0899823X17002501_ref20","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.6287"},{"key":"S0899823X17002501_ref9","unstructured":"Global Strategy for the Diagnosis, Management and Prevention of COPD 2017. Global Initiative for Chronic Obstructive Lung Disease website. http:\/\/goldcopd.org. Published 2017. Accessed November 15, 2017."},{"key":"S0899823X17002501_ref2","unstructured":"Public Health England. English surveillance programme for antimicrobial utilisation and resistance. London, UK; 2014."}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X17002501","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,4,15]],"date-time":"2019-04-15T21:53:34Z","timestamp":1555365214000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X17002501\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,28]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,1]]}},"alternative-id":["S0899823X17002501"],"URL":"https:\/\/doi.org\/10.1017\/ice.2017.250","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,28]]}}}