Different impact of the appropriateness of empirical antibiotics for bacteremia among younger adults and the elderly in the ED.

Sept 2012

Lee CC, Chang CM, Hong MY, Hsu HC, Ko WC.

Source

Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan.

Abstract

OBJECTIVES:

 To investigate the clinical impact of age on bacteremia among adults visiting the emergency department (ED).

METHODS:

 Bacteremic adults visiting the ED from January 2008 to December 2008 were identified retrospectively. Demographic characteristics, severity, bacteremic pathogens with in vitro susceptibility, antimicrobial agents, and outcomes determined from chart records were analyzed as a case-control study.

RESULTS:

 Of 518 eligible bacteremic adults, 288 fifty six percent elderly patients greater then 65 years old were case patients and 230 younger patients, less then 65 years  were regarded as control patients. The 28-day mortality rate was higher in the case patients than that in the control patients (11.8% vs 6.1%, P = .02). The proportion of inappropriate empirical antibiotic therapy between the survivors and nonsurvivors was similar in control patients (69.4% vs 64.3%, P = .77); but for the case patients, the proportion of inappropriate empirical antibiotic therapy in the survivors was lower than that in the non-survivors (27.6% vs 44.1%, P = .04). Of note, inappropriate empirical antibiotic therapy was also one of independent risk factors of 28-day mortality by the multivariate analyses in the case patients (odds ratio [OR] 3.65; P = .049). Other independent predictors of 28-day mortality in case patients included a high Pittsburgh bacteremia score (≥4 points; OR 22.16; P < .001), bacteremia due to foci other than urinary tract infection (OR 9.07; P = .002), malignancy (OR 10.87; P < .001), coronary artery disease (OR 5.68; P = .01), and high serum creatinine (>1.5 mg/dL; OR 3.44; P = .04).

CONCLUSIONS:

For bacteremic adults, this study demonstrated the impact of inappropriate empirical antibiotic therapy on patients' outcome in the elderly was greater than that in the younger adults.

PubMed

National trends in emergency department antibiotic prescribing for children with acute otitis media, 1996 2005.

National trends in emergency department antibiotic prescribing for children with acute otitis media, 1996 2005.

Acad Emerg Med. 2007 Dec

Fischer T, Singer AJ, Lee C, Thode HC Jr.
Department of Emergency Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.

OBJECTIVES: Withholding antibiotics in nontoxic children with acute otitis media (AOM) is now recommended to reduce bacterial resistance rates. Using the National Hospital Ambulatory Medical Care Survey (NHAMCS), the authors describe the national trends for prescribing antibiotics in children with AOM presenting to emergency departments (EDs) in the United States over the past decade. The authors hypothesized that the rates of prescribing antibiotics would decline over time.

METHODS: This was a retrospective study of NHAMCS databases. A national sampling of ED visits for 1996-2005 was used to identify trends in ED prescription of antibiotics to patients with AOM. The National Drug Code Directory Drug Classes were used to identify type of antibiotic prescribed. Frequency and type of antibiotic prescription patterns over time were evaluated.

RESULTS: There were 2.6 million and 2.1 million ED visits for AOM during the first and last years of the study. Children ages 2-12 years accounted for about 40% of all ED visits for AOM, with another 40% in the younger than 2 years age group and 20% in the older than 12 years of age group. During the first and last year of the study, 79.2% and 91.3% of the patients with AOM were prescribed antibiotics, respectively. There was a slight increasing trend in the proportion prescribed antibiotics over time (p = 0.02). The rates of use of antibiotics for AOM were similar in all three age groups.

CONCLUSIONS: There was a slight increase in the percentage of children with AOM who were prescribed antibiotics in the ED between 1996 and 2005. There was also no change in the patterns of prescribing antibiotics.

PMID: 18045893 [PubMed - in process]