The impact of inappropriate antibiotics on bacteremia patients in a community hospital in Taiwan: an emphasis on the impact of referral information for cases from a hospital affiliated nursing home

Abstract

BackgroundEvidence for the impact of inappropriate antimicrobial therapy on bacteremia is mainly from studies in medical centers. We investigated the impact of inappropriate antimicrobial therapy on bacteremia in a community hospital. In particular, patients from the hospital’s affiliated nursing home were sent to the hospital with adequate referral information.MethodsWe performed a retrospective study to collect data of patients with bacteremia in a community hospital in Taiwan from 2005 to 2007.ResultsA total of 222 patients with blood stream infection were diagnosed, of whom 104 patients (46.8%) died. The rate of initial inappropriate antibiotic prescriptions was high (59%). Multivariate analysis revealed that patients with initial inappropriate antibiotics, patients with ventilator support and patients requiring ICU care were the independent predictors for inhospital mortality. Patients referred from the hospital-affiliated nursing home and patients with normal WBC counts had better survival outcome. More than 80% cases infected with methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecalis received initial inappropriate antimicrobial therapy. With the longer delay to administer appropriate antibiotic, a trend of higher mortality rates was observed.ConclusionsBacteremia patients from a hospital-affiliated nursing home had a better prognosis, which may have been due to the adequate referral information. Clinicians should be aware of the commonly ignored drug resistant pathogens, and efforts should be made to avoid delaying the administration of appropriate antibiotic therapy.

Nursing home-associated bloodstream infection: A scoping review

“…The findings of this study 7 were consistent with studies in the 2005 review 1 and will not be discussed further. The literature review identified 6 studies published since 2005 that met the inclusion criteria [8][9][10][11][12][13] : 2 studies evaluated exclusively NHABSI 8,9 and 4 studies compared NHABSI to community-or hospital-associated BSI. [10][11][12][13] Studies that evaluated exclusively NHABSI Table 1 summarizes the characteristics and findings of the 2 studies in which only NHABSI was evaluated.…”

“…The literature review identified 6 studies published since 2005 that met the inclusion criteria [8][9][10][11][12][13] : 2 studies evaluated exclusively NHABSI 8,9 and 4 studies compared NHABSI to community-or hospital-associated BSI. [10][11][12][13] Studies that evaluated exclusively NHABSI Table 1 summarizes the characteristics and findings of the 2 studies in which only NHABSI was evaluated. The study by Almog et al 8 was a letter to the editor and was included in this review because it evaluated a large number of cases of NHABSI (N = 177) and provided information on antibiotic resistance.…”

“…Overall, 4 studies were identified that compared NHABSI with community-or hospital-associated BSI (Table 2). [10][11][12][13] The study population of the 4 studies differed: 2 studies included all episodes of BSI (community-, hospital-, and nursing home-associated) 10,12 ; 1 study focused on those aged ≥ 65 years with community-BSI, hospital-BSI, and NHABSI 11 ; and 1 study focused on those aged ≥65 years with community-onset BSI and NHABSI from a urinary tract source. 13 Only 1 study had a large sample size of NHABSI (N = 252 episodes); 11 in the other 3 studies, the number of episodes ranged from 57 to 77.…”

Rapid Detection of Bloodstream Pathogens in Liver Transplantation Patients With FilmArray Multiplex Polymerase Chain Reaction Assays: Comparison With Conventional Methods

“…Yang et al [22] reported that initial inappropriate antibiotic administration or delayed appropriate antibiotic administration were significantly associated with higher mortality rates in patients with BSI. However, while starting antimicrobial treatment for BSI in transplant patients, a dilemma frequently occurs whether or not to initiate immediate therapy targeted to the suspected infecting agent, in a situation when results from conventional identification methods are available only 24 to 48 h after a positive signal.…”

Prevalence and risk factors for bloodstream infection present on hospital admission

“…Having specific data about the prevalence of antibiotic resistance among common pathogens in patients arriving from nursing homes and the community can improve the specificity and efficacy of initial antibiotic therapy. Such an approach could notably reduce mortality in patients with bacteraemia (Artero et al, 2010; Yang et al, 2013).…”