Prevalence and predictors of initial oral antibiotic treatment failure in adult emergency department patients with cellulitis: a pilot study
Identifieur interne : 001970 ( Main/Exploration ); précédent : 001969; suivant : 001971Prevalence and predictors of initial oral antibiotic treatment failure in adult emergency department patients with cellulitis: a pilot study
Auteurs : Michael Quirke [Irlande (pays)] ; Fiona Boland [Irlande (pays)] ; Tom Fahey [Irlande (pays)] ; Ronan O'Sullivan [Irlande (pays)] ; Arnold Hill [Irlande (pays)] ; Ian Stiell [Canada] ; Abel Wakai [Irlande (pays)]Source :
- BMJ Open [ 2044-6055 ] ; 2015.
Abstract
Assessment of cellulitis severity in the emergency department (ED) setting is problematic. Given the lack of research performed to describe the epidemiology and management of cellulitis, it is unsurprising that heterogeneous antibiotic prescribing and poor adherence to guidelines is common. It has been shown that up to 20.5% of ED patients with cellulitis require either a change in route or dose of the initially prescribed antibiotic regimen. The current treatment failure rate for empirically prescribed oral antibiotic therapy in Irish EDs is unknown. The association of patient risk factors with treatment failure has not been described in our setting. Lower prevalence of community-acquired methicillin-resistant
Consecutive ED patients with cellulitis will be enrolled on a 24/7 basis from 3 Irish EDs. A prespecified set of clinical variables will be measured on each patient discharged on empiric oral antibiotic therapy. A second independent study recruiter will assess at least 10% of cases for each of the predictor variables. Follow-up by telephone call will occur at 14 days for all discharged patients where measurement of the primary outcome will occur. Our primary outcome is treatment failure, defined as a change in route of antibiotic administration from oral to intravenous antibiotic. Our secondary outcome is change in dose or type of prescribed antibiotic. A cohort of approximately 152 patients is required to estimate the proportion of patients failing oral antibiotic treatment with a margin of error of 0.05 around the estimate.
Full ethics approval has been granted. An integrated dissemination plan, involving diverse clinical specialties and enrolled patients, is described.
NCT 02230813.
Url:
DOI: 10.1136/bmjopen-2015-008150
PubMed: 26112223
PubMed Central: 4486970
Affiliations:
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Unit (ECRU), Division of Population Health Sciences (PHS)</addr-line>,<institution>Royal College of Surgeons in Ireland</institution>,<addr-line>Dublin 2</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Boland, Fiona" sort="Boland, Fiona" uniqKey="Boland F" first="Fiona" last="Boland">Fiona Boland</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Division of Population Health Sciences (PHS)</addr-line>,<institution>HRB Centre For Primary Care Research, Royal College of Surgeons in Ireland</institution>,<addr-line>Dublin 2</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Fahey, Tom" sort="Fahey, Tom" uniqKey="Fahey T" first="Tom" last="Fahey">Tom 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Cork</institution>,<addr-line>Cork</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Hill, Arnold" sort="Hill, Arnold" uniqKey="Hill A" first="Arnold" last="Hill">Arnold Hill</name><affiliation wicri:level="1"><nlm:aff id="af6"><addr-line>Department of Clinical Surgery</addr-line>,<institution>Beaumont Hospital,</institution><addr-line>Dublin</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af7"><institution>Medical School, Royal College of Surgeons in Ireland</institution>,<addr-line>Dublin 2</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Stiell, Ian" sort="Stiell, Ian" uniqKey="Stiell I" first="Ian" last="Stiell">Ian Stiell</name><affiliation wicri:level="1"><nlm:aff id="af8"><addr-line>Department of Emergency Medicine</addr-line>,<institution>Ottawa Hospital Research Institute (OHRI), University of Ottawa</institution>,<addr-line>Ottawa, Ontario</addr-line>,<country>Canada</country></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Wakai, Abel" sort="Wakai, Abel" uniqKey="Wakai A" first="Abel" last="Wakai">Abel Wakai</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Emergency Medicine</addr-line>,<institution>Beaumont Hospital</institution>,<addr-line>Dublin</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Emergency Care Research Unit (ECRU), Division of Population Health Sciences (PHS)</addr-line>,<institution>Royal College of Surgeons in Ireland</institution>,<addr-line>Dublin 2</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">BMJ Open</title><idno type="eISSN">2044-6055</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>Assessment of cellulitis severity in the emergency department (ED) setting is problematic. Given the lack of research performed to describe the epidemiology and management of cellulitis, it is unsurprising that heterogeneous antibiotic prescribing and poor adherence to guidelines is common. It has been shown that up to 20.5% of ED patients with cellulitis require either a change in route or dose of the initially prescribed antibiotic regimen. The current treatment failure rate for empirically prescribed oral antibiotic therapy in Irish EDs is unknown. The association of patient risk factors with treatment failure has not been described in our setting. Lower prevalence of community-acquired methicillin-resistant <italic>Staphylococcus aureus</italic>-associated infection, differing antibiotic prescribing preferences and varying availability of outpatient intravenous therapy programmes may result in different rates of empiric antibiotic treatment failure from those previously described.</p></sec><sec><title>Methods and analysis</title><p>Consecutive ED patients with cellulitis will be enrolled on a 24/7 basis from 3 Irish EDs. A prespecified set of clinical variables will be measured on each patient discharged on empiric oral antibiotic therapy. A second independent study recruiter will assess at least 10% of cases for each of the predictor variables. Follow-up by telephone call will occur at 14 days for all discharged patients where measurement of the primary outcome will occur. Our primary outcome is treatment failure, defined as a change in route of antibiotic administration from oral to intravenous antibiotic. Our secondary outcome is change in dose or type of prescribed antibiotic. A cohort of approximately 152 patients is required to estimate the proportion of patients failing oral antibiotic treatment with a margin of error of 0.05 around the estimate.</p></sec><sec><title>Ethics and dissemination</title><p>Full ethics approval has been granted. An integrated dissemination plan, involving diverse clinical specialties and enrolled patients, is described.</p></sec><sec><title>Trial registration number</title><p>NCT 02230813.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Marwick, C" uniqKey="Marwick C">C Marwick</name></author><author><name sortKey="Broomhall, J" uniqKey="Broomhall J">J Broomhall</name></author><author><name sortKey="Mccowan, C" uniqKey="Mccowan C">C McCowan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Eriksson, B" uniqKey="Eriksson B">B Eriksson</name></author><author><name sortKey="Jorup Ronstrom, C" uniqKey="Jorup Ronstrom C">C Jorup-Ronstrom</name></author><author><name sortKey="Karkkonen, K" uniqKey="Karkkonen K">K Karkkonen</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Dong, Sl" uniqKey="Dong S">SL Dong</name></author><author><name sortKey="Kelly, Kd" uniqKey="Kelly K">KD Kelly</name></author><author><name sortKey="Oland, Rc" uniqKey="Oland R">RC Oland</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schrock, Jw" uniqKey="Schrock J">JW Schrock</name></author><author><name sortKey="Laskey, S" uniqKey="Laskey S">S Laskey</name></author><author><name sortKey="Cydulka, Rk" uniqKey="Cydulka R">RK Cydulka</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kilburn, Sa" uniqKey="Kilburn S">SA Kilburn</name></author><author><name sortKey="Featherstone, P" uniqKey="Featherstone P">P Featherstone</name></author><author><name sortKey="Higgins, B" uniqKey="Higgins B">B Higgins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Marwick, C" uniqKey="Marwick C">C Marwick</name></author><author><name sortKey="Rae, N" uniqKey="Rae N">N Rae</name></author><author><name sortKey="Irvine, N" uniqKey="Irvine N">N Irvine</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Eron, Lj" uniqKey="Eron L">LJ Eron</name></author><author><name sortKey="Lipsky, B" uniqKey="Lipsky B">B Lipsky</name></author><author><name sortKey="Low, De" uniqKey="Low D">DE Low</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liu, C" uniqKey="Liu C">C Liu</name></author><author><name sortKey="Bayer, A" uniqKey="Bayer A">A Bayer</name></author><author><name sortKey="Cosgrove, Se" uniqKey="Cosgrove S">SE Cosgrove</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stevens, Dl" uniqKey="Stevens D">DL Stevens</name></author><author><name sortKey="Bisno, Al" uniqKey="Bisno A">AL Bisno</name></author><author><name sortKey="Chambers, Hf" uniqKey="Chambers H">HF Chambers</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ki, V" uniqKey="Ki V">V Ki</name></author><author><name sortKey="Rotstein, C" uniqKey="Rotstein C">C Rotstein</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Murray, H" uniqKey="Murray H">H Murray</name></author><author><name sortKey="Stiell, I" uniqKey="Stiell I">I Stiell</name></author><author><name sortKey="Wells, G" uniqKey="Wells G">G Wells</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Peterson, D" uniqKey="Peterson D">D Peterson</name></author><author><name sortKey="Mcleod, S" uniqKey="Mcleod S">S McLeod</name></author><author><name sortKey="Woolfrey, K" uniqKey="Woolfrey K">K Woolfrey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Merritt, C" uniqKey="Merritt C">C Merritt</name></author><author><name sortKey="Haran, Jp" uniqKey="Haran J">JP Haran</name></author><author><name sortKey="Mintzer, J" uniqKey="Mintzer J">J Mintzer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Frazee, Bw" uniqKey="Frazee B">BW Frazee</name></author><author><name sortKey="Lynn, J" uniqKey="Lynn J">J Lynn</name></author><author><name sortKey="Charlebois, Ed" uniqKey="Charlebois E">ED Charlebois</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gorwitz, Rj" uniqKey="Gorwitz R">RJ Gorwitz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reilly, Bm" uniqKey="Reilly B">BM Reilly</name></author><author><name sortKey="Evans, At" uniqKey="Evans A">AT Evans</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Redmond, Nm" uniqKey="Redmond N">NM Redmond</name></author><author><name sortKey="Davies, R" uniqKey="Davies R">R Davies</name></author><author><name sortKey="Christensen, H" uniqKey="Christensen H">H Christensen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Quirke, M" uniqKey="Quirke M">M Quirke</name></author><author><name sortKey="Saunders, J" uniqKey="Saunders J">J Saunders</name></author><author><name sortKey="O Sullivan, R" uniqKey="O Sullivan R">R O’ Sullivan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Quirke, M" uniqKey="Quirke M">M Quirke</name></author><author><name sortKey="Saunders, J" uniqKey="Saunders J">J Saunders</name></author><author><name sortKey="O Sullivan, R" uniqKey="O Sullivan R">R O'Sullivan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kramer, Ms" uniqKey="Kramer M">MS Kramer</name></author><author><name sortKey="Feinstein, Ar" uniqKey="Feinstein A">AR Feinstein</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Canada</li><li>Irlande (pays)</li></country></list><tree><country name="Irlande (pays)"><noRegion><name sortKey="Quirke, Michael" sort="Quirke, Michael" uniqKey="Quirke M" first="Michael" last="Quirke">Michael Quirke</name></noRegion><name sortKey="Boland, Fiona" sort="Boland, Fiona" uniqKey="Boland F" first="Fiona" last="Boland">Fiona Boland</name><name sortKey="Fahey, Tom" sort="Fahey, Tom" uniqKey="Fahey T" first="Tom" last="Fahey">Tom Fahey</name><name sortKey="Hill, Arnold" sort="Hill, Arnold" uniqKey="Hill A" first="Arnold" last="Hill">Arnold Hill</name><name sortKey="Hill, Arnold" sort="Hill, Arnold" uniqKey="Hill A" first="Arnold" last="Hill">Arnold Hill</name><name sortKey="O Sullivan, Ronan" sort="O Sullivan, Ronan" uniqKey="O Sullivan R" first="Ronan" last="O'Sullivan">Ronan O'Sullivan</name><name sortKey="Quirke, Michael" sort="Quirke, Michael" uniqKey="Quirke M" first="Michael" last="Quirke">Michael Quirke</name><name sortKey="Wakai, Abel" sort="Wakai, Abel" uniqKey="Wakai A" first="Abel" last="Wakai">Abel Wakai</name><name sortKey="Wakai, Abel" sort="Wakai, Abel" uniqKey="Wakai A" first="Abel" last="Wakai">Abel Wakai</name></country><country name="Canada"><noRegion><name sortKey="Stiell, Ian" sort="Stiell, Ian" uniqKey="Stiell I" first="Ian" last="Stiell">Ian Stiell</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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