ArticlePDF Available

1637. Antibiotic Use in Lower Respiratory Tract Infections: Insights From Patient Interviews in Sri Lanka

Authors:

Abstract

Background Antibiotic resistance is an emerging global public health threat with inappropriate use of antibiotics as one of the major drivers. In Sri Lanka, antibiotic consumption is increasing, while little is known about how patients perceive antibiotics. We conducted a qualitative study to better understand patients’ knowledge, perceptions, and attitudes toward antibiotics. Methods Semi-structured interviews were conducted in the local language (Sinhala) and audio recorded for 18 patients with lower respiratory tract infections (LRTI) admitted to a large, public tertiary care hospital in southern Sri Lanka. Interviews were transcribed and then translated into English. Translated interviews were analyzed for themes regarding care-seeking behavior, patients’ knowledge of disease etiology and treatment of LRTI. Results Almost all patients mentioned multiple care visits and polypharmacy prior to admission. When seeking care, patients mainly focused on finding a quick cure, mostly by visiting several different private physicians. However, self-medication was also common. Patients reused prescriptions for antibiotics, kept antibiotics for later use after prematurely stopping their course of treatment and bought antibiotics over-the-counter. Patients’ knowledge of disease etiology and antibiotics was poor. Most patients described non-microbial causes such as exposure to dust and cold weather for their illness. Only a few patients were aware of antibiotic resistance. Despite the desire to receive more information regarding disease and treatment, transfer of information between patients and physicians was limited and mainly confined to prescription instructions. Conclusion This qualitative study in Sri Lanka suggests inappropriate use of antibiotics is a multifactorial problem. Patients’ poor knowledge of disease and treatment, poor information transfer between physicians and patients, high demand for medicines, overprescribing by physicians, and self-medication were found as possible obstructive factors to improve antibiotic usage. To improve antibiotic use, a multifaceted approach is needed with improvement of awareness by patients, public, and physicians regarding antibiotic use and antibiotic resistance. Disclosures All authors: No reported disclosures.
Poster Abstracts • OFID 2019:6 (Suppl 2) • S597
Session: 163. Public Health
Friday, October 4, 2019: 12:15 PM
Background. Yersinia pestis remains endemic in countries throughout Africa,
Asia, and the Americas and is a tier 1 bioterrorism agent. Antibiotic treatment with
aminoglycosides such as streptomycin or gentamicin is eective when initiated early
in the course of illness but can have serious side eects. Alternatives such as uoro-
quinolones, tetracyclines, and sulfonamides are potentially safer but currently lack ro-
bust human data on their ecacy.
Methods. We searched PubMed Central, Medline, Embase, CINAHL, and other
databases for articles in any language with terms related to plague, Yersinia pestis, and
antibiotics. Articles that contained case-level information on antibiotic treatment and
patient outcome were included. We abstracted information related to patient demo-
graphics, clinical features of plague, treatment, and survival using a standardizedform.
Results. Among 4,874 articles identied and screened, we found 723 published
cases of treated plague reported between 1937 and 2016. Fiy-two percent of patients
were male; median age was 22years (range: 8days-80years). Cases were most com-
monly reported from the United States (21%), India (13%), China (11%), Vietnam
(10%), and Madagascar (10%). Overall, the case fatality rate was 21%. e majority
of patients had primary bubonic (64%), pneumonic (21%), or septicemic (4%) plague,
of which survival was 83%, 71%, and 55%, respectively. Among those treated with an
aminoglycoside (n = 386, 53%), survival was 86%. Among those treated with a tetra-
cycline (n = 145, 20%), uoroquinolone (n = 45, 6%), or sulfonamide (n = 311, 43%),
survival was 90%, 84%, and 77%, respectively. Survival rates did not substantially dier
between patients treated with one vs. two classes of antibiotics (table).
Conclusion. Published cases of treated plague oer an opportunity to evaluate the
treatment ecacy of dierent antibiotic classes. In addition to aminoglycosides, tetracyclines,
uoroquinolones, and sulfonamides appear to be eective for plague treatment, although
publication bias and low numbers in certain treatment groups may limit interpretation.
Disclosures. Al l authors: No reported disclosures.
1637. Antibiotic Use in Lower Respiratory Tract Infections: Insights From Patient
Interviews in Sri Lanka
DavidT. vanMelle, MD1; GuusH.A. tenAsbroek, MSc, PhD1;
Sky Vanderburg, MD, MPH2; YohanaW. Abeysinghe, MD3;
Chathurangi Halloluwa, MD3; HelenL. Zhang, MD2;
Tianchen Sheng, MSc2; Kanchana Sewwandi, Msc3;
ChampicaK. Bodinayake, MBBS MD3; Ajith Nagahawatte, MBBS MD3;
ChrisW. Woods, MD 4; Vijitha DeSilva, MBBS MD3;
L.Gayani Tillekeratne, MD, MSc5; 1Amsterdam University Medical Center,
Amsterdam, North Holland, e Netherlands; 2Duke University Medical Center,
Durham, North Carolina; 3University of Ruhuna, Galle, Southern Province, Sri
Lanka; 4Duke University School of Medicine, Durham, North Carolina; 5Duke
University, Durham, North Carolina
Session: 163. Public Health
Friday, October 4, 2019: 12:15 PM
Background. Antibiotic resistance is an emerging global public health threat
with inappropriate use of antibiotics as one of the major drivers. In Sri Lanka, anti-
biotic consumption is increasing, while little is known about how patients perceive
antibiotics. We conducted a qualitative study to better understand patients’ knowledge,
perceptions, and attitudes toward antibiotics.
Methods. Semi-structured interviews were conducted in the local language
(Sinhala) and audio recorded for 18 patients with lower respiratory tract infec-
tions (LRTI) admitted to a large, public tertiary care hospital in southern Sri Lanka.
Interviews were transcribed and then translated into English. Translated interviews
were analyzed for themes regarding care-seeking behavior, patients’ knowledge of dis-
ease etiology and treatment ofLRTI.
Results. Almost all patients mentioned multiple care visits and polypharmacy
prior to admission. When seeking care, patients mainly focused on nding a quick cure,
mostly by visiting several dierent private physicians. However, self-medication was also
common. Patients reused prescriptions for antibiotics, kept antibiotics for later use aer
prematurely stopping their course of treatment and bought antibiotics over-the-counter.
Patients’ knowledge of disease etiology and antibiotics was poor. Most patients described
non-microbial causes such as exposure to dust and cold weather for their illness. Only
a few patients were aware of antibiotic resistance. Despite the desire to receive more in-
formation regarding disease and treatment, transfer of information between patients and
physicians was limited and mainly conned to prescription instructions.
Conclusion. is qualitative study in Sri Lanka suggests inappropriate use of
antibiotics is a multifactorial problem. Patients’ poor knowledge of disease and treat-
ment, poor information transfer between physicians and patients, high demand for
medicines, overprescribing by physicians, and self-medication were found as possible
obstructive factors to improve antibiotic usage. To improve antibiotic use, a multifa-
ceted approach is needed with improvement of awareness by patients, public, and phy-
sicians regarding antibiotic use and antibiotic resistance.
Disclosures. Al l authors: No reported disclosures.
1638. Measles Outbreak Risk Assessment for Transplant Candidates and
Recipients
Elana Kreiger-Benson1; Bruce Gelb, MD1; HenryJ. Neumann, MD1;
Hochman Sarah, MD2; Jennifer Lighter, MD3; SapnaA. Meht a, MD1; 1New York
University School of Medicine, New York, New York; 2New York University Langone
Medical Center–Tisch Hospital, New York, New York; 3New York University Medical
Center, New York, New York
Session: 163. Public Health
Friday, October 4, 2019: 12:15 PM
Background. A measles outbreak began in 2018 with ongoing transmission in
the New York City (NYC) area, aecting children and vulnerable adults. We developed
a systematic 3-part approach to address measles risk in our solid-organ transplant pro-
gram’s adult population by 1)identication of non-immune adults living in at-risk ZIP
codes 2)education focused on risk reduction for all at-risk patients and families and
3)vaccination of non-immune waitlisted patients and consideration of prophylactic
immunoglobulin G (IgG) for post-transplant non-immune patients at high risk for
measles exposure.
Methods. All waitlisted and transplanted patients residing in any of 11 ZIP codes
with recent measles cases in the NYC area as of April 4, 2019, were included. We also
focused on the 4 ZIP codes in the NYC Health Commissioner’s vaccination order from
April 9, 2019. We reviewed electronic medical records (EMR) of patients born aer
1956 for measles immunity by serology or vaccine documentation. A1-page measles
patient education handout was created, reviewed for health literacy appropriateness
and utilized in English and non-English language versions.
Results. 118 waitlisted or previously transplanted patients resided in at-risk
ZIP codes. Among the 118 patients, 56 (47.5%) were presumed immune based
on birth year before 1957. Among 62 patients born in 1957 or later, 5 (8.1%)
had preexisting positive measles IgG in the EMR and 1 patient had documen-
tation of measles vaccination without measles IgG testing. Fifty-seven patients
without EMR evidence of measles immunity were called to undergo measles IgG
testing. 29 patients agreed to testing and an additional 19 patients had the test
added to routine laboratories. Of these 48 patients, 1 was non-immune and 1 had
equivocal immunity. Among transplanted patients identified as non-immune or
with equivocal immune status, a recommendation for prophylactic IgG was made.
All 118 patients received a measles informational handout by mail. Furthermore,
we identified 21 patients born after 1956 living in the 4 zip codes targeted by the
NYC health Commissioner’s order, and among those tested all were found to be
immune.
Conclusion. Asystematic risk assessment during a large measles outbreak identied
at-risk transplant patients and provided timely education and screening for measles immunity.
Disclosures. Al l authors: No reported disclosures.
1639. Outbreak of Human Bartonellosis Due to Bartonella bacilliformis in the
Ecuadorian Andes
David SantiagoLarreateguiRomero1; Lizeth VeronicaLafuenteCevallos2; 1Hospital
Del IESS-Carlos Andrade Marin, Quito, Pichincha, Ecuador; 2Hospital del IESS/
Carlos Andrade Marín, Quito, Pichincha, Ecuador
Session: 163. Public Health
Friday, October 4, 2019: 12:15 PM
Background. Bartonellosis aects small Andean communities in Peru,
Colombia, and Ecuador. Research in this area has been limited; our study presents a
continuous outbreak of cases that occurred in 2018 in areas near the cloud forest of the
EcuadorianAndes.
Methods. Retrospective review of 101 cases of human bartonellosis managed in
Quito - Ecuador, during the last outbreak in our country in the last year (2018). e
study focused upon the most recent outbreak in order to look at current manifestations
of disease and existing practices in diagnosis and management, and how closely these
followed the latest guidelines to manage this disease.
Results. Of the 101 patients reviewed, 52% were male and 48% were female. e
mean age of cases was 24.3years, (mean age of males=23.7, mean age females=25.3).
e median age of patients was 20years (min = 4 years, max= 71 years, IQR = 15).
ere was a peak in acute cases aer the rainy season; mainly in moths march to June,
chronic cases presented less constantly throughout the year. e sensitivity of blood
smear against blood culture in acute disease was 35%. e most commonly used treat-
ment for chronic disease was rifampicin; chloramphenicol and ciprooxacin was used to
treat most acute cases. Complications arose in 16.8% and the most frequent was anemia,
and there were 2 deaths.
Conclusion. Recognize the physiopathological and microbiological characteris-
tics of the disease, as well as improve the diagnostic and treatment algorithms for acute
and chronic bartonellosis which have been developed without a strong evidence base.
Preparation of ready-to-go operational research projects for future outbreaks would
strengthen the evidence base for diagnostic and treatment strategies and enhance
opportunities for control and prevent deaths.
Downloaded from https://academic.oup.com/ofid/article-abstract/6/Supplement_2/S597/5605768 by guest on 24 October 2019
ResearchGate has not been able to resolve any citations for this publication.
ResearchGate has not been able to resolve any references for this publication.