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    Factors influencing the development of antibiotic associated diarrhea in ED patients discharged home: risk of administering IV antibiotics

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    Authors
    Haran, John P
    Hayward, Gregory
    Skinner, Stephen
    Merritt, Chris
    Hoaglin, David C.
    Hibberd, Patricia L.
    Lu, Shan
    Boyer, Edward W.
    Faculty Advisor
    John Haran
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Department of Emergency Medicine
    Senior Scholars Program
    Document Type
    Journal Article
    Publication Date
    2014-10-01
    Keywords
    Administration, Intravenous
    Administration, Oral
    Adult
    African Americans
    Anti-Bacterial Agents
    Cohort Studies
    Diarrhea
    *Emergency Service, Hospital
    Enterocolitis, Pseudomembranous
    European Continental Ancestry Group
    Female
    Hispanic Americans
    Humans
    Logistic Models
    Male
    Middle Aged
    Multivariate Analysis
    Odds Ratio
    Prospective Studies
    Risk Factors
    Bacterial Infections and Mycoses
    Emergency Medicine
    Pathological Conditions, Signs and Symptoms
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    Link to Full Text
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465134/
    Abstract
    OBJECTIVE: Antibiotic-associated diarrhea (AAD) and Clostridium difficile infection (CDI) are well-known outcomes from antibiotic administration. Because emergency department (ED) visits frequently result in antibiotic use, we evaluated the frequency of AAD/CDI in adults treated and discharged home with new prescriptions for antibiotics to identify risk factors for acquiring AAD/CDI. METHODS: This prospective multicenter cohort study enrolled adult patients who received antibiotics in the ED and were discharged with a new prescription for antibiotics. Antibiotic-associated diarrhea was defined as 3 or more loose stools for 2 days or more within 30 days of starting the antibiotic. C difficile infection was defined by the detection of toxin A or B within this same period. We used multivariate logistic regression to assess predictors of developing AAD. RESULTS: We enrolled and followed 247 patients; 45 (18%) developed AAD, and 2 (1%) developed CDI. Patients who received intravenous (IV) antibiotics in the ED were more likely to develop AAD/CDI than patients who did not: 25.7% (95% confidence interval [CI], 17.4-34.0) vs 12.3% (95% CI, 6.8-17.9). Intravenous antibiotics had adjusted odds ratio of 2.73 (95% CI, 1.38-5.43), and Hispanic ethnicity had adjusted odds ratio of 3.04 (95% CI, 1.40-6.58). Both patients with CDI had received IV doses of broad-spectrum antibiotics. CONCLUSION: Intravenous antibiotic therapy administered to ED patients before discharge was associated with higher rates of AAD and with 2 cases of CDI. Care should be taken when deciding to use broad-spectrum IV antibiotics to treat ED patients before discharge home.
    Source
    Am J Emerg Med. 2014 Oct;32(10):1195-9. doi: 10.1016/j.ajem.2014.07.015. Epub 2014 Jul 30. Link to article on publisher's site
    DOI
    10.1016/j.ajem.2014.07.015
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/49271
    PubMed ID
    25149599
    Notes

    Stephen Skinner participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School.

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    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ajem.2014.07.015
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    T.H. Chan School of Medicine Student Publications
    Senior Scholars Program
    Emergency Medicine Publications

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