Predictors of Appropriate Antibiotic Use in Bacteremia Patients Presenting at the Emergency Department

Abstract

Sepsis is a condition that requires appropriate antibiotic treatment at the emergency department (ED). Most previous studies conducted on inappropriate antibiotic use at the ED were conducted in developed countries with a low percentage of sepsis. This study aimed to find additional clinical predictors for appropriate antibiotic use in bacteremia patients presenting at the ED from a developing country, in which there is a higher proportion of patients with sepsis. We included adult patients who presented at the ED with clinical suspicion of infection and bacteremia. Patients allocated to the appropriate antibiotic group were those in whom the prescribed antibiotic was sensitive to the pathogen. Predictors and outcomes of appropriate antibiotic use were analyzed. A total of 3133 patients who met the study criteria presented at the ED during the study period. Of those, 271 patients were diagnosed with bacteremia, 48 of whom (17.71%) received inappropriate antibiotic prescriptions. Only pulse rate was an independent factor for appropriate antibiotic treatment, with an adjusted odds ratio of 1.019 (95% CI of 1.001, 1.036). In terms of clinical outcomes, the inappropriate antibiotic group had higher proportions of 28-day mortality (29.17% vs. 25.25%; p-value = 0.022) and longer hospitalization (14 vs. 9 days; p-value = 0.003). This study found that inappropriate antibiotics were prescribed in 17% of bacteremia patients presenting at the ED and that high pulse rate was an indicator for appropriate antibiotic prescription. Patients with inappropriate antibiotic administration had longer hospitalization and higher 28-day mortality than those who received appropriate antibiotic treatment.

The Diagnostic Values of Peptidoglycan, Lipopolysaccharide, and (1,3)-Beta-D-Glucan in Patients with Suspected Bloodstream Infection: A Single Center, Prospective Study

“…The most frequently isolated Gram-positive bacteria were Enterococcus faecium (20%), Staphylococcus aureus (15%), and Staphylococcus epidermis (15%) in peripheral blood, and Enterococcus faecium (45.5%) in sterile body fluids and other sterile tissues. The most frequently isolated fungi was Candida albicans (50%) in peripheral blood samples of patients with BSI, which is consistent with previous publications [ 19 ]. Pneumocystis jirovecii (69.6%) was the main pathogen found in sterile body fluids and other sterile tissues, which was significantly different from the common fungal pathogen in BSIs.…”

Evaluation of antibiotic appropriateness at an outpatient oncology centre

“…Factors with a p-value of less than 0.25 in univariate analysis were subsequently included in the logistic regression analysis to determine predictors of inappropriate antibiotic choice. 39 The Hosmer-Lemeshow method was used to test for goodness of fit for the model. An a priori alpha (α) of 0.05 was used to define statistical significance.…”

Antibiotic prescribing errors generated by the use of an electronic prescribing system in the emergency department: A mixed-method study

“…In the United States, at least one antibiotic is prescribed to around 7% to 8% of cases admitted to the ED on a daily basis (Harrison and Ouyang, 2013). Phungoen et al (2019) studied patients who were admitted to the ED having sepsis. It was found that almost a fifth (17%) of the ED admitted patients received inappropriate antibiotics and resulted in a longer stay in the hospital and an increased mortality rate.…”