Antibiotic-associated diarrhoea in emergency department observation unit patients.
Clostridium difficile diarrhoea is an urgent threat to patients, but little is known about the role of antibiotic administration that starts in emergency department observation units (EDOUs). We studied risk factors for antibiotic-associated diarrhoea (AAD) and C. difficile infection (CDI) in EDOU patients. This prospective cohort study enrolled adult patients discharged after EDOU antibiotic treatment between January 2013 and 2014. We obtained medical histories, EDOU treatment and occurrence of AAD and CDI over 28 days after discharge. We enrolled and followed 275 patients treated with antibiotics in the EDOU. We found that 52 (18·6%) developed AAD and four (1·5%) had CDI. Patients treated with vancomycin [relative risk (RR) 0·52, 95% confidence interval (CI) 0·3-0·9] were less likely to develop AAD. History of developing diarrhoea with antibiotics (RR 3·11, 95% CI 1·92-5·03) and currently failing antibiotics (RR 1·90, 95% CI 1·14-3·16) were also predictors of AAD. Patients with CDI were likely to be treated with clindamycin. In conclusion, AAD occurred in almost 20% of EDOU patients with risk factors including a previous history of diarrhoea with antibiotics and prior antibiotic therapy, while the risk of AAD was lower in patients receiving treatment regimens utilizing intravenous vancomycin.
Department of Emergency Medicine,University of Massachusetts Medical School,Worcester,MA,USA.
J P
JP
Haran
Department of Emergency Medicine,University of Massachusetts Medical School,Worcester,MA,USA.
G
G
Wu
Department of Biology,University of Massachusetts Dartmouth,North Dartmouth,MA,USA.
V
V
Bucci
Department of Emergency Medicine,University of Massachusetts Medical School,Worcester,MA,USA.
A
A
Fischer
Department of Emergency Medicine,University of Massachusetts Medical School,Worcester,MA,USA.
L
L
Keang
Department of Emergency Medicine,University of Massachusetts Medical School,Worcester,MA,USA.
E W
EW
Boyer
Department of Pediatrics and Division of Global Health,Harvard Medical School,Boston,MA,USA.
P L
PL
Hibberd
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000187:drug effects*; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004636:Emergency Service, Hospital; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
D000900:Anti-Bacterial Agents
Antibiotics; Clostridium difficile; diarrhoea; gastrointestinal infections; infectious disease