1. Appropriateness of antibiotic prescribing for patients with sepsis in rural hospital emergency departments.
- Author
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Heffernan, A. J., Smedley, A., Stickley, T., Oomen, S., Carrigan, B., Heffernan, R., Woodall, H., Pinidiyapathirage, J., and Brumpton, K.
- Subjects
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ANTIMICROBIAL stewardship , *STATISTICS , *HOSPITAL emergency services , *CONFIDENCE intervals , *MEDICAL information storage & retrieval systems , *SAMPLE size (Statistics) , *RURAL conditions , *MULTIPLE regression analysis , *MULTIVARIATE analysis , *RETROSPECTIVE studies , *ACQUISITION of data , *RESPIRATORY infections , *MANN Whitney U Test , *FISHER exact test , *GENTAMICIN , *SEPSIS , *HOSPITAL mortality , *MEDICAL protocols , *SURVEYS , *T-test (Statistics) , *PEARSON correlation (Statistics) , *INAPPROPRIATE prescribing (Medicine) , *DRUG prescribing , *MEDICAL records , *DESCRIPTIVE statistics , *GENITOURINARY diseases , *EMERGENCY medical services , *CHI-squared test , *PHYSICIAN practice patterns , *ODDS ratio , *METROPOLITAN areas , *DATA analysis software , *ANTIBIOTICS , *LONGITUDINAL method , *EVALUATION - Abstract
Design/Participants: This was a multicentre retrospective cohort study of adult patients (≥18 years) presenting with a process associated International Classification of Diseases code (ICD‐AM‐10) pertaining to sepsis between January 2017 and July 2020 to rural Emergency Departments. Main Outcome Measures: Our primary outcome was antibiotic appropriateness as defined by the Australian Therapeutic Guidelines (for antibiotic selection relative to infecting source) and the National Antimicrobial Prescribing Survey tool. Our secondary outcome was in‐hospital mortality. Methods: Relevant clinical and non‐clinical, physiological and laboratory data were collected retrospectively. Multivariate logistic regression was used to estimate the odds of both inappropriate antibiotic prescribing and in‐hospital mortality based on clinical and non‐clinical factors. Results: A total of 378 patients were included who primarily presented with sepsis of unknown origin (36.8%), a genitourinary (22.22%) or respiratory (18.78%) source. Antibiotics were appropriately prescribed in 59% of patients. A positive Quick Sequential Organ Failure Assessment score (qSOFA) (odds ratio [OR] = 0.49; 95% confidence interval [CI], 0.29–0.83), a respiratory infection source (OR = 0.5; 95% CI, 0.29–0.86) and documented allergy (OR = 0.42; 95% CI, 0.25–0.72) were associated with a lower risk of appropriate prescribing in multivariate analysis. Forty‐one percent of patients received antibiotics within 1 h of presentation. Inappropriate antibiotic prescribing was not associated with in‐hospital mortality. Conclusion: The rates of appropriate antibiotic prescribing in rural Emergency Departments for patients presenting with sepsis is low, but comparable to other referral metropolitan centres. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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