title: The impact of inappropriate antibiotics on bacteremia patients in a community hospital in Taiwan: an emphasis on the impact of referral information for cases from a hospital affiliated nursing home.
abstract: BACKGROUND
  Evidence for the impact of inappropriate antimicrobial therapy on bacteremia is mainly from studies in medical centers. We investigated the impact of inappropriate antimicrobial therapy on bacteremia in a community hospital. In particular, patients from the hospital's affiliated nursing home were sent to the hospital with adequate referral information.
  
  
  METHODS
  We performed a retrospective study to collect data of patients with bacteremia in a community hospital in Taiwan from 2005 to 2007.
  
  
  RESULTS
  A total of 222 patients with blood stream infection were diagnosed, of whom 104 patients (46.8%) died. The rate of initial inappropriate antibiotic prescriptions was high (59%). Multivariate analysis revealed that patients with initial inappropriate antibiotics, patients with ventilator support and patients requiring ICU care were the independent predictors for inhospital mortality. Patients referred from the hospital-affiliated nursing home and patients with normal WBC counts had better survival outcome. More than 80% cases infected with methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecalis received initial inappropriate antimicrobial therapy. With the longer delay to administer appropriate antibiotic, a trend of higher mortality rates was observed.
  
  
  CONCLUSIONS
  Bacteremia patients from a hospital-affiliated nursing home had a better prognosis, which may have been due to the adequate referral information. Clinicians should be aware of the commonly ignored drug resistant pathogens, and efforts should be made to avoid delaying the administration of appropriate antibiotic therapy.
authors.forename: Chih-Jen
authors.initials: CJ
authors.lastname: Yang
authors.forename: Yu-Chieh
authors.initials: YC
authors.lastname: Chung
authors.forename: Tun-Chieh
authors.initials: TC
authors.lastname: Chen
authors.forename: Hsu-Liang
authors.initials: HL
authors.lastname: Chang
authors.forename: Ying-Ming
authors.initials: YM
authors.lastname: Tsai
authors.forename: Ming-Shyan
authors.initials: MS
authors.lastname: Huang
authors.forename: Yen-Hsu
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. idpaul@gmail.com.
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lu
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents