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dc.contributor.advisorJohn Haran
dc.contributor.authorHaran, John P
dc.contributor.authorHayward, Gregory
dc.contributor.authorSkinner, Stephen
dc.contributor.authorMerritt, Chris
dc.contributor.authorHoaglin, David C
dc.contributor.authorHibberd, Patricia L.
dc.contributor.authorLu, Shan
dc.contributor.authorBoyer, Edward W.
dc.date2022-08-11T08:10:55.000
dc.date.accessioned2022-08-23T17:24:48Z
dc.date.available2022-08-23T17:24:48Z
dc.date.issued2014-10-01
dc.date.submitted2016-03-28
dc.identifier.citationAm 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.issn0735-6757 (Linking)
dc.identifier.doi10.1016/j.ajem.2014.07.015
dc.identifier.pmid25149599
dc.identifier.urihttp://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.abstractOBJECTIVE: 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.isoen_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.urlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465134/
dc.subjectAdministration, Intravenous
dc.subjectAdministration, Oral
dc.subjectAdult
dc.subjectAfrican Americans
dc.subjectAnti-Bacterial Agents
dc.subjectCohort Studies
dc.subjectDiarrhea
dc.subject*Emergency Service, Hospital
dc.subjectEnterocolitis, Pseudomembranous
dc.subjectEuropean Continental Ancestry Group
dc.subjectFemale
dc.subjectHispanic Americans
dc.subjectHumans
dc.subjectLogistic Models
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectMultivariate Analysis
dc.subjectOdds Ratio
dc.subjectProspective Studies
dc.subjectRisk Factors
dc.subjectBacterial Infections and Mycoses
dc.subjectEmergency Medicine
dc.subjectPathological Conditions, Signs and Symptoms
dc.titleFactors influencing the development of antibiotic associated diarrhea in ED patients discharged home: risk of administering IV antibiotics
dc.typeJournal Article
dc.source.journaltitleThe American journal of emergency medicine
dc.source.volume32
dc.source.issue10
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/ssp/214
dc.identifier.contextkey8390987
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.submissionpathssp/214
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.contributor.departmentDepartment of Emergency Medicine
dc.contributor.departmentSenior Scholars Program
dc.source.pages1195-9


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