Antibiotic-associated diarrhoea in emergency department observation unit patients

Abstract

Clostridium difficile diarrhoea is an urgent threat to patients, but little is known about the role of antibiotic administration that starts in emergency department observation units (EDOUs). We studied risk factors for antibiotic-associated diarrhoea (AAD) and C. difficile infection (CDI) in EDOU patients. This prospective cohort study enrolled adult patients discharged after EDOU antibiotic treatment between January 2013 and 2014. We obtained medical histories, EDOU treatment and occurrence of AAD and CDI over 28 days after discharge. We enrolled and followed 275 patients treated with antibiotics in the EDOU. We found that 52 (18·6%) developed AAD and four (1·5%) had CDI. Patients treated with vancomycin [relative risk (RR) 0·52, 95% confidence interval (CI) 0·3-0·9] were less likely to develop AAD. History of developing diarrhoea with antibiotics (RR 3·11, 95% CI 1·92-5·03) and currently failing antibiotics (RR 1·90, 95% CI 1·14-3·16) were also predictors of AAD. Patients with CDI were likely to be treated with clindamycin. In conclusion, AAD occurred in almost 20% of EDOU patients with risk factors including a previous history of diarrhoea with antibiotics and prior antibiotic therapy, while the risk of AAD was lower in patients receiving treatment regimens utilizing intravenous vancomycin.

Antibiotic prescribing and the risk of antibiotic–associated diarrhoea in Korle Bu Teaching Hospital, Ghana: a pilot study

“…After analysis of the results, it could be inferred that the occurrence of AAD is dependent on the type of antibiotic the patient was on before the onset of the diarrhoea (p = 0.034). Other studies on AAD have also reported this [16,23]. For instance, Wistrom and associates observed that treatment with cephalosporins, clindamycin or broadspectrum antibiotics was associated with higher risk during their prospective study to determine the frequency of AAD [16].…”

“…However, studies to determine the risk and prevalence of antibioticassociated diarrhoea in Ghana, which as aforementioned, is one of the common complications of antibiotic therapy is limited. Many excellent studies and reviews however, have been done in other countries [23][24][25]. Though these results may partially correlate with the prevalence and risk of AAD worldwide, they cannot be fully projected to Ghana.…”

Drug-Related Enteropathy

“…Prevalence is highly variable and can be influenced by reporting country, age, and hospital setting. For instance, antibiotic-associated diarrhea (AAD) represent between 3.2-29% of all causes of diarrhea, with a mean prevalence of 9.6%, in the emergency department this figure raises to 18.6%, and in the intensive care units range from 13.9 to 21.5% [34][35][36]. Risk factors for AAD are: increasing age, therapy with more than 1 antibiotic, clindamycin use, long-term antibiotic use, and concomitant PPI use.…”

ieta nti-flamatoria or DAIN: A Crohn's disease management strategy tailored for Puerto Ricans

“…We will build on our experience with 1) penalized generalized linear models [ [52] , [53] , [54] , [55] ] and 2) random forest classification and regression [ 56 , 57 ] to identify microbial features predicted to be significantly affected by food categories of DAIN or is associated with inflammation or with clinical outcomes: clinical response and remission (adjusted p-value <0.05). For the penalized generalized linear models, we will use the R package glmnet and an L1 (or LASSO) penalization to infer each modeled species contribution to individual food category (i.e., prebiotics, probiotics, etc.)…”