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

Haran, John P.; Hayward, Gregory; Skinner, S.J.M.; Merritt, Chris; Hoaglin, David C.; Hibberd, Patricia L.; Lü, Shan; Boyer, Edward W.

doi:10.1016/j.ajem.2014.07.015

Cited by 23 publications

(24 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…3 A recent ED study found that even a single dose of broad-spectrum intravenous antibiotics prior to discharge was associated with antibiotic-associated diarrhea and Clostridium difficile infection. 4 Despite this, practice patterns are highly variable. 5,6 Treatment decisions have been complicated further by the increasing prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA).…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial treatment decision for non-purulent skin and soft tissue infections in the emergency department

Yadav

Gatien

Corrales–Medina

et al. 2016

CJEM

View full text Add to dashboard Cite

Objectives: We surveyed Canadian emergency physicians to determine how skin and soft tissue infections (SSTIs) are managed and which risk factors were felt to be important in predicting failure with oral antibiotics. Methods: We performed an electronic survey of physician members of the Canadian Association of Emergency Physicians (CAEP) using the modified Dillman method. Results: The survey response rate was 36.9% (n = 391) amongst CAEP members. There was a lack of consensus regarding management of SSTIs. CAEP respondents identified 14 risk factors for predicting treatment failure with oral antibiotics, including hypotension, tachypnea, and patient reported severity of pain >8 of 10. Conclusions: The survey demonstrates significant variability regarding physician management of SSTIs, and we have identified several perceived risk factors for treatment failure with oral antibiotics that should be assessed in future studies.

show abstract

Section: Introductionmentioning

confidence: 99%

Antimicrobial treatment decision for non-purulent skin and soft tissue infections in the emergency department

Yadav

Gatien

Corrales–Medina

et al. 2016

CJEM

View full text Add to dashboard Cite

show abstract

“…In a prospective, randomized controlled trial (n = 92), Maraví-Poma and colleages 76 demonstrated a 3-fold increase in the incidence of local and systemic fungal infection with Candida albicans (from 7% to 22%) in patients with prolonged treatment with prophylactic antibiotics, a finding consistent with those of other similar studies. [77][78][79] In addition, overuse of antibiotics is associated with the increased risk of antibiotic-associated diarrhea and Clostridium difficile colitis 80 and with the selection of resistant organisms, 81 all of which suggest that the adverse effects of prophylactic antibiotic coverage outweighs any benefit offered by the practice.…”

Section: Prophylactic Antibioticsmentioning

confidence: 99%

Clinical practice guideline: management of acute pancreatitis

Greenberg¹,

Hsu²,

Bawazeer³

et al. 2016

cjs

340

352

View full text Add to dashboard Cite

There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the management of complications of acute pancreatitis and of gall stone-induced pancreatitis.Une hausse de l'incidence de pancréatite aiguë a été constatée à l'échelle mondiale. Malgré l'amélioration de l'accès aux soins et aux techniques d'imagerie et d'intervention, la pancréatite aiguë est toujours associée à une morbidité et une mortalité importantes. Bien qu'il existe des guides de pratique clinique pour la prise en charge de la pancréatite aiguë, des études récentes sur la vérification de la prise en charge clinique de cette affection révèlent des lacunes importantes dans la conformité aux recommandations fondées sur des données probantes. Ces résultats mettent en relief l'importance de formuler des recommandations compréhensibles et applicables pour le diagnostic et la prise en charge de la pancréatite aiguë. La présente ligne directrice vise à fournir des recommandations fondées sur des données probantes pour la prise en charge de la pancréatite aiguë, qu'elle soit bénigne ou grave, ainsi que de ses complications et de celles de la pancréatite causée par un calcul biliaire.A cute pancreatitis can range from a mild, self-limiting disease that requires no more than supportive measures to severe disease with lifethreatening complications. The most common causes of acute pan creatitis are gallstones and binge alcohol consumption.1 There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality.A systematic review of clinical practice guidelines for the management of acute pancreatitis revealed 14 guidelines published between 2004 and 2008 alone.2 Although these guidelines have significant overlap in their recommendations for diagnosing and managing acute pancreatitis, there is disagreement in some aspects of both the timing and types of interventions that should be used for both mild and severe acute pancreatitis. The availability of new imaging modalities and noninvasive therapies has also changed clinical practice. Finally, despite the availability of guidelines, recent studies auditing clinical management of acute pancreatitis have sh...

show abstract

“…Intravenous antibiotic use is associated with higher rates of antibiotic-associated diarrhea. 6 We identified one case of Clostridium difficile infection following EDOU treatment in a 54 year old woman that was, according to national guidelines, over-treated for leg cellulitis.…”

Section: Discussionmentioning

confidence: 99%

“…Based off of our previous work 6 where we observed a 10% gender difference in the under-treated group and using a desired power of 0.8 with an alpha of 0.05 we arrived at a sample size of 188 patients. Given the EDOU volume from the preceding year we estimated that a twelve-month enrollment period would be sufficient to obtain this sample size.…”

Section: Methodsmentioning

confidence: 99%

“…Unfortunately, physician discretion in selecting antibiotic regimens leads to a variability in ED treatment approaches to common bacterial infections. 6 Given the risks of bacterial resistance due to inappropriate antibiotic use, physician practices in prescribing antibiotics in the EDOU is unknown and deserves attention. 4,7 The objectives of this cohort study, therefore, were to: 1) describe the prevalence of various antibiotic prescribing practices for patients with SSTIs, 2) compare these management practices with national guidelines, and 3) identify factors that might influence physician’s prescribing practices.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of bacterial skin infections in ED observation units: factors influencing prescribing practice

Haran

Bucci

et al. 2015

The American Journal of Emergency Medicine

Self Cite

View full text Add to dashboard Cite

Objective The Infectious Disease Society of America (IDSA) publishes evidence based guidelines for the treatment of skin and soft tissue infections. How closely physicians follow these guidelines is unknown, particularly in the Emergency Department Observation Unit (EDOU) where increasing numbers of patients are treatment for these infections. Our objectives were to describe: 1) the antibiotic treatment patterns EDOU patients, 2) physicians’ adherence to the IDSA guidelines, and 3) factors that influence physician’s prescribing practices. Methods This prospective cohort enrolled adult patients discharged from an EDOU at an academic medical center after treatment for a skin or soft tissue infection. Information was collected from chart review and patient interview pertaining to the patient’s socio-demographic characteristics, presenting illness, and antibiotic treatment regimens. Treatment regimens were compared with national guidelines. Results The study included 193 patients of which only 43% were treated according to IDSA guidelines; 42% were over-treated and 15% were under-treated. Women were more likely to be under-treated (RR 1.58; 95% CI 1.21 to 2.06), while patients 50 years and older were at risk for over-treatment (RR 1.44; 95% CI 1.03, 2.02). Women also received shorter courses of antibiotic therapy with an average of 9.6 days of treatment compared with 10.6 days for men. Conclusions Physician antibiotic prescribing practices demonstrated poor adherence to IDSA guidelines and were influenced by the patient’s age and gender. Standardized antibiotic protocols for treatment of skin and soft tissue infections to IDSA guidelines in the EDOU would minimize physician bias.

show abstract

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

Cited by 23 publications

References 25 publications

Antimicrobial treatment decision for non-purulent skin and soft tissue infections in the emergency department

Antimicrobial treatment decision for non-purulent skin and soft tissue infections in the emergency department

Clinical practice guideline: management of acute pancreatitis

Treatment of bacterial skin infections in ED observation units: factors influencing prescribing practice

Contact Info

Product

Resources

About