Association of Adverse Events With Antibiotic Use in Hospitalized Patients

Abstract

<div class="section"> <a class="named-anchor" id="ab-ioi170042-1"> <!-- named anchor --> </a> <h5 class="section-title" id="d7302507e306">Question</h5> <p id="d7302507e308">What is the likelihood of developing antibiotic-associated adverse drug events (ADEs) for hospitalized patients receiving antibiotic therapy? </p> </div><div class="section"> <a class="named-anchor" id="ab-ioi170042-2"> <!-- named anchor --> </a> <h5 class="section-title" id="d7302507e311">Findings</h5> <p id="d7302507e313">In this cohort study, medical records of 1488 adult inpatients were examined for 30 days after antibiotic initiation for the development of the following antibiotic-associated ADEs: gastrointestinal, dermatologic, musculoskeletal, hematologic, hepatobiliary, renal, cardiac, and neurologic; and 90 days for the development of <i>Clostridium difficile</i> infection or incident multidrug-resistant organism infection. Twenty percent of patients experienced at least 1 antibiotic-associated ADE. </p> </div><div class="section"> <a class="named-anchor" id="ab-ioi170042-3"> <!-- named anchor --> </a> <h5 class="section-title" id="d7302507e319">Meaning</h5> <p id="d7302507e321">These findings underscore the importance of judicious antibiotic prescribing to reduce the harm that can result from antibiotic-associated ADEs. </p> </div><p class="first" id="d7302507e324">This cohort study describes the incidence of antibiotic-associated adverse drug events for adult inpatients receiving systemic antibiotic therapy. </p><div class="section"> <a class="named-anchor" id="ab-ioi170042-4"> <!-- named anchor --> </a> <h5 class="section-title" id="d7302507e328">Importance</h5> <p id="d7302507e330">Estimates of the incidence of overall antibiotic-associated adverse drug events (ADEs) in hospitalized patients are generally unavailable. </p> </div><div class="section"> <a class="named-anchor" id="ab-ioi170042-5"> <!-- named anchor --> </a> <h5 class="section-title" id="d7302507e333">Objective</h5> <p id="d7302507e335">To describe the incidence of antibiotic-associated ADEs for adult inpatients receiving systemic antibiotic therapy. </p> </div><div class="section"> <a class="named-anchor" id="ab-ioi170042-6"> <!-- named anchor --> </a> <h5 class="section-title" id="d7302507e338">Design, Setting, and Participants</h5> <p id="d7302507e340">Retrospective cohort of adult inpatients admitted to general medicine wards at an academic medical center. </p> </div><div class="section"> <a class="named-anchor" id="ab-ioi170042-7"> <!-- named anchor --> </a> <h5 class="section-title" id="d7302507e343">Exposures</h5> <p id="d7302507e345">At least 24 hours of any parenteral or oral antibiotic therapy.</p> </div><div class="section"> <a class="named-anchor" id="ab-ioi170042-8"> <!-- named anchor --> </a> <h5 class="section-title" id="d7302507e348">Main Outcomes and Measures</h5> <p id="d7302507e350">Medical records of 1488 patients were examined for 30 days after antibiotic initiation for the development of the following antibiotic-associated ADEs: gastrointestinal, dermatologic, musculoskeletal, hematologic, hepatobiliary, renal, cardiac, and neurologic; and 90 days for the development of <i>Clostridium difficile</i> infection or incident multidrug-resistant organism infection, based on adjudication by 2 infectious diseases trained clinicians. </p> </div><div class="section"> <a class="named-anchor" id="ab-ioi170042-9"> <!-- named anchor --> </a> <h5 class="section-title" id="d7302507e356">Results</h5> <p id="d7302507e358">In 1488 patients, the median age was 59 years (interquartile range, 49-69 years), and 758 (51%) participants were female. A total of 298 (20%) patients experienced at least 1 antibiotic-associated ADE. Furthermore, 56 (20%) non–clinically indicated antibiotic regimens were associated with an ADE, including 7 cases of <i>C difficile </i>infection. Every additional 10 days of antibiotic therapy conferred a 3% increased risk of an ADE. The most common ADEs were gastrointestinal, renal, and hematologic abnormalities, accounting for 78 (42%), 45 (24%), and 28 (15%) 30-day ADEs, respectively. Notable differences were identified between the incidence of ADEs associated with specific antibiotics. </p> </div><div class="section"> <a class="named-anchor" id="ab-ioi170042-10"> <!-- named anchor --> </a> <h5 class="section-title" id="d7302507e364">Conclusions and Relevance</h5> <p id="d7302507e366">Although antibiotics may play a critical role when used appropriately, our findings underscore the importance of judicious antibiotic prescribing to reduce the harm that can result from antibiotic-associated ADEs. </p> </div>