Factors influencing the development of antibiotic associated diarrhea in ED patients discharged home: risk of administering IV antibiotics
dc.contributor.advisor | John Haran | |
dc.contributor.author | Haran, John P | |
dc.contributor.author | Hayward, Gregory | |
dc.contributor.author | Skinner, Stephen | |
dc.contributor.author | Merritt, Chris | |
dc.contributor.author | Hoaglin, David C | |
dc.contributor.author | Hibberd, Patricia L. | |
dc.contributor.author | Lu, Shan | |
dc.contributor.author | Boyer, Edward W. | |
dc.date | 2022-08-11T08:10:55.000 | |
dc.date.accessioned | 2022-08-23T17:24:48Z | |
dc.date.available | 2022-08-23T17:24:48Z | |
dc.date.issued | 2014-10-01 | |
dc.date.submitted | 2016-03-28 | |
dc.identifier.citation | Am J Emerg Med. 2014 Oct;32(10):1195-9. doi: 10.1016/j.ajem.2014.07.015. Epub 2014 Jul 30. <a href="http://dx.doi.org/10.1016/j.ajem.2014.07.015">Link to article on publisher's site</a> | |
dc.identifier.issn | 0735-6757 (Linking) | |
dc.identifier.doi | 10.1016/j.ajem.2014.07.015 | |
dc.identifier.pmid | 25149599 | |
dc.identifier.uri | http://hdl.handle.net/20.500.14038/49271 | |
dc.description | <p>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.</p> | |
dc.description.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. | |
dc.language.iso | en_US | |
dc.relation | <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=25149599&dopt=Abstract">Link to Article in PubMed</a> | |
dc.relation.url | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465134/ | |
dc.subject | Administration, Intravenous | |
dc.subject | Administration, Oral | |
dc.subject | Adult | |
dc.subject | African Americans | |
dc.subject | Anti-Bacterial Agents | |
dc.subject | Cohort Studies | |
dc.subject | Diarrhea | |
dc.subject | *Emergency Service, Hospital | |
dc.subject | Enterocolitis, Pseudomembranous | |
dc.subject | European Continental Ancestry Group | |
dc.subject | Female | |
dc.subject | Hispanic Americans | |
dc.subject | Humans | |
dc.subject | Logistic Models | |
dc.subject | Male | |
dc.subject | Middle Aged | |
dc.subject | Multivariate Analysis | |
dc.subject | Odds Ratio | |
dc.subject | Prospective Studies | |
dc.subject | Risk Factors | |
dc.subject | Bacterial Infections and Mycoses | |
dc.subject | Emergency Medicine | |
dc.subject | Pathological Conditions, Signs and Symptoms | |
dc.title | Factors influencing the development of antibiotic associated diarrhea in ED patients discharged home: risk of administering IV antibiotics | |
dc.type | Journal Article | |
dc.source.journaltitle | The American journal of emergency medicine | |
dc.source.volume | 32 | |
dc.source.issue | 10 | |
dc.identifier.legacycoverpage | https://escholarship.umassmed.edu/ssp/214 | |
dc.identifier.contextkey | 8390987 | |
html.description.abstract | <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> | |
dc.identifier.submissionpath | ssp/214 | |
dc.contributor.department | Department of Quantitative Health Sciences | |
dc.contributor.department | Department of Emergency Medicine | |
dc.contributor.department | Senior Scholars Program | |
dc.source.pages | 1195-9 |