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Open Access Highly Accessed Research article

The impact of inappropriate antibiotics on bacteremia patients in a community hospital in Taiwan: an emphasis on the impact of referral information for cases from a hospital affiliated nursing home

Chih-Jen Yang1245, Yu-Chieh Chung24, Tun-Chieh Chen135, Hsu-Liang Chang12, Ying-Ming Tsai12, Ming-Shyan Huang25, Yen-Hsu Chen3 and Po-Liang Lu356*

Author Affiliations

1 Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

2 Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

3 Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

4 Wen-Hsiung Hospital, Kaohsiung, Taiwan

5 College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

6 Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, #100, Tzyou 1st Road, Kaohsiung City 807, Taiwan

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BMC Infectious Diseases 2013, 13:500  doi:10.1186/1471-2334-13-500

Published: 24 October 2013

Abstract

Background

Evidence for the impact of inappropriate antimicrobial therapy on bacteremia is mainly from studies in medical centers. We investigated the impact of inappropriate antimicrobial therapy on bacteremia in a community hospital. In particular, patients from the hospital’s affiliated nursing home were sent to the hospital with adequate referral information.

Methods

We performed a retrospective study to collect data of patients with bacteremia in a community hospital in Taiwan from 2005 to 2007.

Results

A total of 222 patients with blood stream infection were diagnosed, of whom 104 patients (46.8%) died. The rate of initial inappropriate antibiotic prescriptions was high (59%). Multivariate analysis revealed that patients with initial inappropriate antibiotics, patients with ventilator support and patients requiring ICU care were the independent predictors for inhospital mortality. Patients referred from the hospital-affiliated nursing home and patients with normal WBC counts had better survival outcome. More than 80% cases infected with methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecalis received initial inappropriate antimicrobial therapy. With the longer delay to administer appropriate antibiotic, a trend of higher mortality rates was observed.

Conclusions

Bacteremia patients from a hospital-affiliated nursing home had a better prognosis, which may have been due to the adequate referral information. Clinicians should be aware of the commonly ignored drug resistant pathogens, and efforts should be made to avoid delaying the administration of appropriate antibiotic therapy.

Keywords:
Bacteremia; Nursing home; Inappropriate antibiotics; Community hospital