Prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department patients with acute bacterial skin and skin structure infections: a pilot, prospective cohort study
Objective To determine the prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department (ED) patients with acute bacterial skin and skin structure infections (ABSSSIs).Design Multicentre, pilot cohort study.Setting Three urban EDs in Dublin, Ireland.Participant...
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BMJ Publishing Group
2020-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/8/e034057.full |
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| author | Fiona Boland Tom Fahey Stephen Kelly Michael Quirke Niamh Mitchell Jarlath Varley Adrian Moughty Joseph McKeever Abel Wakai |
| author_facet | Fiona Boland Tom Fahey Stephen Kelly Michael Quirke Niamh Mitchell Jarlath Varley Adrian Moughty Joseph McKeever Abel Wakai |
| author_sort | Fiona Boland |
| collection | DOAJ |
| description | Objective To determine the prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department (ED) patients with acute bacterial skin and skin structure infections (ABSSSIs).Design Multicentre, pilot cohort study.Setting Three urban EDs in Dublin, Ireland.Participants Consecutive ED patients aged >16 years old with ABSSSIs between March 2015 and September 2016.Intervention Oral flucloxacillin 500 mg–1 g four times a day (alternative in penicillin allergy).Primary and secondary outcome measures The primary outcome was to determine the prevalence and predictors of oral to intravenous antibiotic switch. Secondary outcomes were to determine the prevalence and predictors of receiving an extended course of oral antibiotic treatment and measurement of interobserver reliability for clinical predictors at enrolment.Results Overall, 159 patients were enrolled of which eight were lost to follow-up and five were excluded. The majority of patients were male (65.1%) and <50 years of age (58.2%). Oral to intravenous antibiotic switch occurred in 13 patients (8.9%; 95% CI 4.8% to 14.7%). Increased lesion size (OR 1.74; 95% CI 1.09 to 2.79), white cell count (OR 1.32; 95% CI 1.05 to 1.67), athlete’s foot (OR 8.00; 95% CI 2.31 to 27.71) and fungal nail infections (OR 7.25; 95% CI 1.99 to 26.35) were associated with oral to intravenous antibiotic switch. 24.8% (95% CI 18.1% to 33.0%) of patients received an extended course of oral antibiotic treatment.Conclusion The prevalence of oral to intravenous antibiotic switch in this pilot study is 8.9% (95% CI 4.8% to 14.7%). We identify the predictors of oral to intravenous switch worthy of future investigation.Trial registration number NCT02230813. |
| format | Article |
| id | doaj-art-072e87ae958f49ee8fc96ec511b93adf |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-072e87ae958f49ee8fc96ec511b93adf2024-12-03T05:55:10ZengBMJ Publishing GroupBMJ Open2044-60552020-08-0110810.1136/bmjopen-2019-034057Prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department patients with acute bacterial skin and skin structure infections: a pilot, prospective cohort studyFiona Boland0Tom Fahey1Stephen Kelly2Michael Quirke3Niamh Mitchell4Jarlath Varley5Adrian Moughty6Joseph McKeever7Abel Wakai8Data Science Centre, Royal College of Surgeons Ireland (RCSI) University of Medicine and Health Sciences, Dublin, IrelandHRB Centre For Primary Care Research, Department of General Practice, Royal College of Surgeons Ireland, Dublin, IrelandBarts Health NHS Trust, Rheumatology, London, United KingdomSurgery, Queen Mary University of London, London, UKDepartment of Emergency Medicine, Connolly Hospital Blanchardstown, Blanchardstown, Dublin, IrelandDepartment of Emergency Medicine, Connolly Hospital Blanchardstown, Blanchardstown, Dublin, IrelandDepartment of Emergency Medicine, Mater Misericordiae University Hospital, Dublin, IrelandDepartment of Emergency Medicine, Connolly Hospital Blanchardstown, Blanchardstown, Dublin, IrelandEmergency Care Research Unit, Royal College of Surgeons Ireland, Dublin, IrelandObjective To determine the prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department (ED) patients with acute bacterial skin and skin structure infections (ABSSSIs).Design Multicentre, pilot cohort study.Setting Three urban EDs in Dublin, Ireland.Participants Consecutive ED patients aged >16 years old with ABSSSIs between March 2015 and September 2016.Intervention Oral flucloxacillin 500 mg–1 g four times a day (alternative in penicillin allergy).Primary and secondary outcome measures The primary outcome was to determine the prevalence and predictors of oral to intravenous antibiotic switch. Secondary outcomes were to determine the prevalence and predictors of receiving an extended course of oral antibiotic treatment and measurement of interobserver reliability for clinical predictors at enrolment.Results Overall, 159 patients were enrolled of which eight were lost to follow-up and five were excluded. The majority of patients were male (65.1%) and <50 years of age (58.2%). Oral to intravenous antibiotic switch occurred in 13 patients (8.9%; 95% CI 4.8% to 14.7%). Increased lesion size (OR 1.74; 95% CI 1.09 to 2.79), white cell count (OR 1.32; 95% CI 1.05 to 1.67), athlete’s foot (OR 8.00; 95% CI 2.31 to 27.71) and fungal nail infections (OR 7.25; 95% CI 1.99 to 26.35) were associated with oral to intravenous antibiotic switch. 24.8% (95% CI 18.1% to 33.0%) of patients received an extended course of oral antibiotic treatment.Conclusion The prevalence of oral to intravenous antibiotic switch in this pilot study is 8.9% (95% CI 4.8% to 14.7%). We identify the predictors of oral to intravenous switch worthy of future investigation.Trial registration number NCT02230813.https://bmjopen.bmj.com/content/10/8/e034057.full |
| spellingShingle | Fiona Boland Tom Fahey Stephen Kelly Michael Quirke Niamh Mitchell Jarlath Varley Adrian Moughty Joseph McKeever Abel Wakai Prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department patients with acute bacterial skin and skin structure infections: a pilot, prospective cohort study BMJ Open |
| title | Prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department patients with acute bacterial skin and skin structure infections: a pilot, prospective cohort study |
| title_full | Prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department patients with acute bacterial skin and skin structure infections: a pilot, prospective cohort study |
| title_fullStr | Prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department patients with acute bacterial skin and skin structure infections: a pilot, prospective cohort study |
| title_full_unstemmed | Prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department patients with acute bacterial skin and skin structure infections: a pilot, prospective cohort study |
| title_short | Prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department patients with acute bacterial skin and skin structure infections: a pilot, prospective cohort study |
| title_sort | prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department patients with acute bacterial skin and skin structure infections a pilot prospective cohort study |
| url | https://bmjopen.bmj.com/content/10/8/e034057.full |
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