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A cross-sectional study of blood cultures and antibiotic use in patients admitted from the Emergency Department: missed opportunities for antimicrobial stewardship.

Shallcross LJ, Freemantle N, Nisar S, Ray D - BMC Infect. Dis. (2016)

Bottom Line: Early review of antimicrobial prescribing decisions within 48 h is recommended to reduce the overall use of unnecessary antibiotics, and in particular the use of broad-spectrum antibiotics.More than half of parenteral antibiotics used were either co-amoxiclav or piperacillin-tazobactam.Parenteral antibiotics are frequently used in those admitted from the Emergency Department; they are usually broad spectrum and are usually initiated without first obtaining cultures.

View Article: PubMed Central - PubMed

Affiliation: UCL Centre for Infectious Disease Informatics, Farr Institute of Health Informatics Research, 222 Euston Road, London, NW1 2DA, UK. l.shallcross@ucl.ac.uk.

ABSTRACT

Background: Early review of antimicrobial prescribing decisions within 48 h is recommended to reduce the overall use of unnecessary antibiotics, and in particular the use of broad-spectrum antibiotics. When parenteral antibiotics are used, blood culture results provide valuable information to help decide whether to continue, alter or stop antibiotics at 48 h. The objective of this study was to investigate the frequency of parenteral antibiotic use, broad spectrum antibiotic use and use of blood cultures when parenteral antibiotics are initiated in patients admitted via the Emergency Department.

Methods: We used electronic health records from patients admitted from the Emergency Department at University Hospital Birmingham in 2014.

Results: Six percent (4562/72939) of patients attending the Emergency department and one-fifth (4357/19034) of those patients admitted to hospital were prescribed a parenteral antimicrobial. More than half of parenteral antibiotics used were either co-amoxiclav or piperacillin-tazobactam. Blood cultures were obtained in less than one-third of patients who were treated with a parenteral antibiotic.

Conclusions: Parenteral antibiotics are frequently used in those admitted from the Emergency Department; they are usually broad spectrum and are usually initiated without first obtaining cultures. Blood cultures may have limited value to support prescribing review as part of antimicrobial stewardship initiatives.

No MeSH data available.


Use of blood cultures and parenteral antibiotics within the 48 h following hospital admission, by age and gender, 2014
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Fig2: Use of blood cultures and parenteral antibiotics within the 48 h following hospital admission, by age and gender, 2014

Mentions: Amongst 19034 patients who were admitted to hospital from the ED, 4357 (22.9 %) received a parenteral antimicrobial within the first 48 h and 2365 patients (12.4 %) had a specimen taken for blood culture, Fig. 1. An organism was identified in 11.9 % (282/2365) of patients with a blood culture, with E. coli (78/282) and S. aureus (21/282) as the leading causes of bacteraemia, Table 1. Overall the use of blood cultures and parenteral antibiotics was more frequent in men compared to women and increased from age 30 years and above, rising sharply in the elderly, from age 60 years in men and age 70 years in women. At all ages the use of parenteral antibiotics far exceeded the use of blood cultures, Fig. 2.Table 1


A cross-sectional study of blood cultures and antibiotic use in patients admitted from the Emergency Department: missed opportunities for antimicrobial stewardship.

Shallcross LJ, Freemantle N, Nisar S, Ray D - BMC Infect. Dis. (2016)

Use of blood cultures and parenteral antibiotics within the 48 h following hospital admission, by age and gender, 2014
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835863&req=5

Fig2: Use of blood cultures and parenteral antibiotics within the 48 h following hospital admission, by age and gender, 2014
Mentions: Amongst 19034 patients who were admitted to hospital from the ED, 4357 (22.9 %) received a parenteral antimicrobial within the first 48 h and 2365 patients (12.4 %) had a specimen taken for blood culture, Fig. 1. An organism was identified in 11.9 % (282/2365) of patients with a blood culture, with E. coli (78/282) and S. aureus (21/282) as the leading causes of bacteraemia, Table 1. Overall the use of blood cultures and parenteral antibiotics was more frequent in men compared to women and increased from age 30 years and above, rising sharply in the elderly, from age 60 years in men and age 70 years in women. At all ages the use of parenteral antibiotics far exceeded the use of blood cultures, Fig. 2.Table 1

Bottom Line: Early review of antimicrobial prescribing decisions within 48 h is recommended to reduce the overall use of unnecessary antibiotics, and in particular the use of broad-spectrum antibiotics.More than half of parenteral antibiotics used were either co-amoxiclav or piperacillin-tazobactam.Parenteral antibiotics are frequently used in those admitted from the Emergency Department; they are usually broad spectrum and are usually initiated without first obtaining cultures.

View Article: PubMed Central - PubMed

Affiliation: UCL Centre for Infectious Disease Informatics, Farr Institute of Health Informatics Research, 222 Euston Road, London, NW1 2DA, UK. l.shallcross@ucl.ac.uk.

ABSTRACT

Background: Early review of antimicrobial prescribing decisions within 48 h is recommended to reduce the overall use of unnecessary antibiotics, and in particular the use of broad-spectrum antibiotics. When parenteral antibiotics are used, blood culture results provide valuable information to help decide whether to continue, alter or stop antibiotics at 48 h. The objective of this study was to investigate the frequency of parenteral antibiotic use, broad spectrum antibiotic use and use of blood cultures when parenteral antibiotics are initiated in patients admitted via the Emergency Department.

Methods: We used electronic health records from patients admitted from the Emergency Department at University Hospital Birmingham in 2014.

Results: Six percent (4562/72939) of patients attending the Emergency department and one-fifth (4357/19034) of those patients admitted to hospital were prescribed a parenteral antimicrobial. More than half of parenteral antibiotics used were either co-amoxiclav or piperacillin-tazobactam. Blood cultures were obtained in less than one-third of patients who were treated with a parenteral antibiotic.

Conclusions: Parenteral antibiotics are frequently used in those admitted from the Emergency Department; they are usually broad spectrum and are usually initiated without first obtaining cultures. Blood cultures may have limited value to support prescribing review as part of antimicrobial stewardship initiatives.

No MeSH data available.