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Jabak SJ, Kawam L, El Mokahal A, Sharara AI. Management of acute diarrhea in the emergency department of a tertiary care university medical center. J Int Med Res 2022; 50:3000605221115385. [PMID: 35942579 PMCID: PMC9373141 DOI: 10.1177/03000605221115385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To examine the management of acute diarrhea in the emergency department (ED)
of a large university medical center. Methods Retrospective cross-sectional study over a 10-month period of adult patients
(age ≥18 years) presenting to the ED with acute diarrhea. Results Data for 780 patients were reviewed; 101 met the exclusion criteria. Of the
679 patients with acute community-acquired diarrhea, 582 (85.7%) were
discharged home and constituted the study cohort of mostly healthy adults
(mean age: 32.5 ± 14.5 years). The rate of antibiotic prescription at
discharge was 26%. Inappropriate use of antibiotics occurred in 28% of the
patients. The presence of fever (odds ratio (OR) = 3.52), leukocytosis
(OR = 1.72), and older age (OR = 1.16) were predictors of antibiotic
prescription. Patients with dehydration, comorbidities, or bloody diarrhea
were more likely to receive antibiotics. Microbiological studies and
cross-sectional imaging were ordered in 12.4% and 11.7% of the patients,
respectively, but provided very low yield (<10% for both) resulting in
significantly higher visit charges. Inappropriately prescribed antibiotics
at discharge resulted in higher charges in the ED compared with no
antibiotic prescription. Conclusion Acute diarrhea management in our ED is suboptimal and does not adhere to
practice guidelines, resulting in unnecessary antibiotic prescriptions,
investigations, and cost.
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Affiliation(s)
| | | | | | - Ala I Sharara
- Ala I. Sharara, Professor of Medicine,
Division of Gastroenterology, American University of Beirut Medical Center, Riad
El-Solh, Beirut 1107 2020, Lebanon.
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Gavhane J, Patra V, Amonkar P. Prescribing pattern for acute diarrhea in children: A survey of pediatricians from Maharashtra, India. MULLER JOURNAL OF MEDICAL SCIENCES AND RESEARCH 2022. [DOI: 10.4103/mjmsr.mjmsr_4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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3
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Is Recent Exposure to Antibiotics a Risk Factor for Hospitalisation in Korean Children with Acute Non-Bacterial Gastroenteritis? A Nationwide Population-Based Study. CHILDREN 2021; 8:children8090809. [PMID: 34572241 PMCID: PMC8467275 DOI: 10.3390/children8090809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to evaluate the effect of recent antibiotic therapy and probiotics on hospitalisation in children with acute gastroenteritis. Using a retrospective study design, data from the population aged up to 18 years were collected from the Korean National Health Insurance Service-National Sample Cohort. The duration of antibiotic therapy within 14 days of the index visit, prescription of probiotics at initial presentation, the effect size of antibiotic exposure on hospitalisation, and its modification by probiotics were assessed. Of 275,395 patients with acute gastroenteritis, 51,008 (18.5%) had prior exposure to antibiotics. Hospitalisation within 7 days of the index visit was positively associated with exposure to antibiotics (p-trend < 0.001). The prescription of probiotics (as a main effect; odds ratio, 0.80; 95% confidence interval 0.72–0.87) was associated with a decreased risk of hospitalisation. Prior exposure to antibiotics might be a significant risk factor for hospitalisation in children presenting with acute gastroenteritis. This may be favourably modified by administering probiotics at the initial presentation.
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Abstract
BACKGROUND This study investigated recent trends in antibiotic use and factors associated with antibiotic use among children with acute infectious diarrhea. We obtained records of outpatients aged under 18 years diagnosed with acute infectious diarrhea from the Japan Medical Data Center database during 2012-2015. OBJECTIVE We investigated prescription patterns of antibiotics at their initial visit and evaluated factors associated with antibiotic usage using multivariable log-binomial regression models. RESULTS Overall, we identified 4493 patients diagnosed with acute infectious diarrhea; 29.6% received antibiotics. The most commonly prescribed antibiotic is fosfomycin (20.3%). In multivariable log-binomial regression analysis, out-of-hour visits, clinical diagnoses of suspected bacterial enterocolitis, private outpatient clinics, and pediatric departments are significantly associated with higher prevalence of antibiotic use. CONCLUSIONS Antibiotics are over-prescribed for children with acute infectious diarrhea. Our investigation provides important information to promote education of physicians and of health policy considerations for appropriate antibiotic prescription practices.
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Wojkowska-Mach J, Godman B, Glassman A, Kurdi A, Pilc A, Rozanska A, Skoczyński S, Wałaszek M, Bochenek T. Antibiotic consumption and antimicrobial resistance in Poland; findings and implications. Antimicrob Resist Infect Control 2018; 7:136. [PMID: 30473786 PMCID: PMC6238284 DOI: 10.1186/s13756-018-0428-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/30/2018] [Indexed: 11/19/2022] Open
Abstract
Background The problem of inappropriate use of antibiotics and the resulting growth in antimicrobial resistance (AMR) has implications for Poland and the world. The objective of this paper was to compare and contrast antibiotic resistance and antibiotic utilisation in Poland in recent years versus other European countries, including agreed quality indicators, alongside current AMR patterns and ongoing policies and initiatives in Poland to influence and improve antibiotic prescribing. Methods A quantitative ten-year analysis (2007–2016) of the use of antibiotics based on European Centre for Disease Prevention and Control (ECDC) data combined with a literature review on AMR rates and antimicrobial stewardship initiatives. Results The system of monitoring AMR and appropriate strategies to address AMR rates remain underdeveloped in Poland. The role of microbiological diagnostics and efforts to prevent infections is currently underestimated by physicians. Overall, Poland had one of the highest rates of total consumption of antibiotics in the analysed European countries. Total consumption of antibacterials for systemic use and relative consumption of beta-lactamase sensitive penicillins were characterized by small but statistically significant average annual increases between 2007 and 2016 (from 22.2 DIDs to 23.9 DIDs and from 0.8 to 1.3%, respectively). Conclusions The integrated activities around appropriate antibiotic prescribing in the pre- and post-graduate training of physicians and dentists seem to be particularly important, as well as changes in policies on prescribing antibiotics within ambulatory care. AMR and appropriate prescribing of antibiotics should be the focus of health policy actions in Poland.
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Affiliation(s)
- Jadwiga Wojkowska-Mach
- 1Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18 Str., 31-121, Krakow, Poland
| | - Brian Godman
- 2Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, G4 ORE, Glasgow, UK.,3Health Economics Centre, Liverpool University Management School, Chatham Street, Liverpool, UK.,4Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.,5Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Amanda Glassman
- 6Center for Global Development, 2055 L Street NW, Washington, DC 20036 USA
| | - Amanj Kurdi
- 2Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, G4 ORE, Glasgow, UK.,7Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Andrzej Pilc
- 8Department of Neurobiology, Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland.,9Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Grzegorzecka 20 Str., 31-531, Krakow, Poland
| | - Anna Rozanska
- 1Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18 Str., 31-121, Krakow, Poland
| | - Szymon Skoczyński
- 10Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Marta Wałaszek
- 11Department of Nursing, Institute of Health Sciences, State Higher Vocational School in Tarnów, Tarnów, Poland
| | - Tomasz Bochenek
- 9Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Grzegorzecka 20 Str., 31-531, Krakow, Poland
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6
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Schmutz C, Bless PJ, Mäusezahl D, Jost M, Mäusezahl-Feuz M. Acute gastroenteritis in primary care: a longitudinal study in the Swiss Sentinel Surveillance Network, Sentinella. Infection 2017; 45:811-824. [PMID: 28779435 PMCID: PMC5696444 DOI: 10.1007/s15010-017-1049-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Acute gastroenteritis (AG) leads to considerable burden of disease, health care costs and socio-economic impact worldwide. We assessed the frequency of medical consultations and work absenteeism due to AG at primary care level, and physicians' case management using the Swiss Sentinel Surveillance Network "Sentinella". METHODS During the 1-year, longitudinal study in 2014, 172 physicians participating in "Sentinella" reported consultations due to AG including information on clinical presentation, stool diagnostics, treatment, and work absenteeism. RESULTS An incidence of 2146 first consultations due to AG at primary care level per 100,000 inhabitants in Switzerland was calculated for 2014 based on reported 3.9 thousand cases. Physicians classified patients' general condition at first consultation with a median score of 7 (1 = poor, 10 = good). The majority (92%) of patients received dietary recommendations and/or medical prescriptions; antibiotics were prescribed in 8.5%. Stool testing was initiated in 12.3% of cases; more frequently in patients reporting recent travel. Among employees (15-64 years), 86.3% were on sick leave. Median duration of sick leave was 4 days. CONCLUSIONS The burden of AG in primary care is high and comparable with that of influenza-like illness (ILI) in Switzerland. Work absenteeism is substantial, leading to considerable socio-economic impact. Mandatory infectious disease surveillance underestimates the burden of AG considering that stool testing is not conducted routinely. While a national strategy to reduce the burden of ILI exists, similar comprehensive prevention efforts should be considered for AG.
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Affiliation(s)
- Claudia Schmutz
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Philipp Justus Bless
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Daniel Mäusezahl
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
| | - Marianne Jost
- Federal Office of Public Health, Schwarzenburgstrasse 157, 3003, Bern, Switzerland
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Różańska A, Pac A, Romanik M, Bulanda M, Wójkowska-Mach J. Outpatient post-partum antibiotic prescription: method of identification of infection control areas demanding improvements and verification of sensitivity of infection registration. J Antimicrob Chemother 2017; 73:240-245. [DOI: 10.1093/jac/dkx369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/10/2017] [Indexed: 11/14/2022] Open
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Spina A, Kerr KG, Cormican M, Barbut F, Eigentler A, Zerva L, Tassios P, Popescu GA, Rafila A, Eerola E, Batista J, Maass M, Aschbacher R, Olsen KEP, Allerberger F. Spectrum of enteropathogens detected by the FilmArray GI Panel in a multicentre study of community-acquired gastroenteritis. Clin Microbiol Infect 2015; 21:719-28. [PMID: 25908431 DOI: 10.1016/j.cmi.2015.04.007] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/05/2015] [Accepted: 04/09/2015] [Indexed: 11/18/2022]
Abstract
The European, multicentre, quarterly point-prevalence study of community-acquired diarrhoea (EUCODI) analysed stool samples received at ten participating clinical microbiology laboratories (Austria, Finland, France, Germany, Greece, Ireland, Italy, Portugal, Romania, and the UK) in 2014. On four specified days, each local laboratory submitted samples from ≤20 consecutive patients to the Austrian Study Centre for further testing with the FilmArray GI Panel (BioFire Diagnostics, Salt Lake City, UT, USA). Of the 709 samples from as many patients received, 325 (45.8%) tested negative, 268 (37.8%) yielded only one organism, and 116 (16.4%) yielded multiple organisms. Positivity rates ranged from 41% (30 of 73 samples) in France to 74% (59 of 80 samples) in Romania. With the exception of Entamoeba histolytica and Vibrio cholerae, all of the 22 targeted pathogens were detected at least once. Enteropathogenic Escherichia coli, Campylobacter species, toxigenic Clostridium difficile, enteroaggregative E. coli, norovirus and enterotoxigenic E. coli were the six most commonly detected pathogens. When tested according to local protocols, seven of 128 positive samples (5.5%) yielded multiple organisms. Overall, the FilmArray GI Panel detected at least one organism in 54.2% (384/709) of the samples, as compared with 18.1% (128/709) when testing was performed with conventional techniques locally. This underlines the considerable potential of multiplex PCR to improve routine stool diagnostics in community-acquired diarrhoea. Classic culture methods directed at the isolation of specific pathogens are increasingly becoming second-line tools, being deployed when rapid molecular tests give positive results. This optimizes the yield from stool examinations and dramatically improves the timeliness of diagnosis.
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Affiliation(s)
- A Spina
- Austrian Agency for Health and Food Safety, Vienna, Austria
| | - K G Kerr
- Harrogate & District NHS Foundation Trust, Harrogate, UK
| | - M Cormican
- National University of Ireland, Galway, Ireland
| | - F Barbut
- Hôpital Saint-Antoine, Paris, France
| | | | - L Zerva
- Attikon University Hospital, Athens-Chaidari, Greece
| | - P Tassios
- Attikon University Hospital, Athens-Chaidari, Greece
| | - G A Popescu
- National Institute for Infectious Diseases and Carol Davila University, Bucharest, Romania
| | - A Rafila
- National Institute for Infectious Diseases and Carol Davila University, Bucharest, Romania
| | - E Eerola
- Turku University, Turku, Finland
| | - J Batista
- Occidental Hospital Centre, Lisbon, Portugal
| | - M Maass
- Labor Dr Heidrich & Kollegen MVZ, Hamburg, Germany
| | - R Aschbacher
- Laboratorio Aziendale di Microbiologia e Virologia, Bolzano, Italy
| | | | - F Allerberger
- Austrian Agency for Health and Food Safety, Vienna, Austria.
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Comparative evaluation of two commercial multiplex panels for detection of gastrointestinal pathogens by use of clinical stool specimens. J Clin Microbiol 2014; 52:3667-73. [PMID: 25100818 DOI: 10.1128/jcm.01637-14] [Citation(s) in RCA: 210] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The detection of pathogens associated with gastrointestinal disease may be important in certain patient populations, such as immunocompromised hosts, the critically ill, or individuals with prolonged disease that is refractory to treatment. In this study, we evaluated two commercially available multiplex panels (the FilmArray gastrointestinal [GI] panel [BioFire Diagnostics, Salt Lake City, UT] and the Luminex xTag gastrointestinal pathogen panel [GPP] [Luminex Corporation, Toronto, Canada]) using Cary-Blair stool samples (n = 500) submitted to our laboratory for routine GI testing (e.g., culture, antigen testing, microscopy, and individual real-time PCR). At the time of this study, the prototype (non-FDA-cleared) FilmArray GI panel targeted 23 pathogens (14 bacterial, 5 viral, and 4 parasitic), and testing of 200 μl of Cary-Blair stool was recommended. In contrast, the Luminex GPP assay was FDA cleared for the detection of 11 pathogens (7 bacterial, 2 viral, and 2 parasitic), but had the capacity to identify 4 additional pathogens using a research-use-only protocol. Importantly, the Luminex assay was FDA cleared for 100 μl raw stool; however, 100 μl Cary-Blair stool was tested by the Luminex assay in this study. Among 230 prospectively collected samples, routine testing was positive for one or more GI pathogens in 19 (8.3%) samples, compared to 76 (33.0%) by the FilmArray and 69 (30.3%) by the Luminex assay. Clostridium difficile (12.6 to 13.9% prevalence) and norovirus genogroup I (GI)/GII (5.7 to 13.9% prevalence) were two of the pathogens most commonly detected by both assays among prospective samples. Sapovirus was also commonly detected (5.7% positive rate) by the FilmArray assay. Among 270 additional previously characterized samples, both multiplex panels demonstrated high sensitivity (>90%) for the majority of targets, with the exception of several pathogens, notably Aeromonas sp. (23.8%) by FilmArray and Yersinia enterocolitica (48.1%) by the Luminex assay. Interestingly, the FilmArray and Luminex panels identified mixed infections in 21.1% and 13.0% of positive prospective samples, respectively, compared to only 8.3% by routine methods.
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