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The association between adherence to national antibiotic guidelines and mortality, readmission and length of stay in hospital inpatients: results from a Norwegian multicentre, observational cohort study

BACKGROUND: Clinical antibiotic prescribing guidelines are essential in defining responsible use in the local context. Our objective was to investigate the association between adherence to national antibiotic prescribing guidelines and patient outcomes across a wide range of infectious diseases in h...

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Autores principales: Wathne, Jannicke Slettli, Harthug, Stig, Kleppe, Lars Kåre Selland, Blix, Hege Salvesen, Nilsen, Roy M., Charani, Esmita, Smith, Ingrid
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466722/
https://www.ncbi.nlm.nih.gov/pubmed/31011417
http://dx.doi.org/10.1186/s13756-019-0515-5
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author Wathne, Jannicke Slettli
Harthug, Stig
Kleppe, Lars Kåre Selland
Blix, Hege Salvesen
Nilsen, Roy M.
Charani, Esmita
Smith, Ingrid
author_facet Wathne, Jannicke Slettli
Harthug, Stig
Kleppe, Lars Kåre Selland
Blix, Hege Salvesen
Nilsen, Roy M.
Charani, Esmita
Smith, Ingrid
author_sort Wathne, Jannicke Slettli
collection PubMed
description BACKGROUND: Clinical antibiotic prescribing guidelines are essential in defining responsible use in the local context. Our objective was to investigate the association between adherence to national antibiotic prescribing guidelines and patient outcomes across a wide range of infectious diseases in hospital inpatients. METHODS: Over five months in 2014, inpatients receiving antibiotics under the care of pulmonary medicine, infectious diseases and gastroenterology specialties across three university hospitals in Western Norway were included in this observational cohort study. Patient and antibiotic prescribing data gathered from electronic medical records included indication for antibiotics, microbiology test results, discharge diagnoses, length of stay (LOS), comorbidity, estimated glomerular filtration rate (eGFR) on admission and patient outcomes (primary: 30-day mortality; secondary: in-hospital mortality, 30-day readmission and LOS). Antibiotic prescriptions were classified as adherent or non-adherent to national guidelines according to documented indication for treatment. Patient outcomes were analysed according to status for adherence to guidelines using multivariate logistic, linear and competing risk regression analysis with adjustments made for comorbidity, age, sex, indication for treatment, seasonality and whether the patient was admitted from an institution or not. RESULTS: In total, 1756 patients were included in the study. 30-day-mortality and in-hospital mortality were lower (OR = 0.48, p = 0.003 and OR = 0.46, p = 0.001) in the guideline adherent group, compared to the non-adherent group. Adherence to guideline did not affect 30-day readmission. In linear regression analysis there was a trend towards shorter LOS when LOS was analysed for patients discharged alive (predicted mean difference − 0.47, 95% CI (− 1.02, 0.07), p = 0.081). In competing risk analysis of LOS, the adherent group had a subdistribution hazard ratio (SHR) of 1.17 95% CI (1.02, 1.34), p = 0.025 for discharge compared to the non-adherent group. CONCLUSIONS: Adhering to antibiotic guidelines when treating infections in hospital inpatients was associated with favourable patient outcomes in terms of mortality and LOS. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13756-019-0515-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-64667222019-04-22 The association between adherence to national antibiotic guidelines and mortality, readmission and length of stay in hospital inpatients: results from a Norwegian multicentre, observational cohort study Wathne, Jannicke Slettli Harthug, Stig Kleppe, Lars Kåre Selland Blix, Hege Salvesen Nilsen, Roy M. Charani, Esmita Smith, Ingrid Antimicrob Resist Infect Control Research BACKGROUND: Clinical antibiotic prescribing guidelines are essential in defining responsible use in the local context. Our objective was to investigate the association between adherence to national antibiotic prescribing guidelines and patient outcomes across a wide range of infectious diseases in hospital inpatients. METHODS: Over five months in 2014, inpatients receiving antibiotics under the care of pulmonary medicine, infectious diseases and gastroenterology specialties across three university hospitals in Western Norway were included in this observational cohort study. Patient and antibiotic prescribing data gathered from electronic medical records included indication for antibiotics, microbiology test results, discharge diagnoses, length of stay (LOS), comorbidity, estimated glomerular filtration rate (eGFR) on admission and patient outcomes (primary: 30-day mortality; secondary: in-hospital mortality, 30-day readmission and LOS). Antibiotic prescriptions were classified as adherent or non-adherent to national guidelines according to documented indication for treatment. Patient outcomes were analysed according to status for adherence to guidelines using multivariate logistic, linear and competing risk regression analysis with adjustments made for comorbidity, age, sex, indication for treatment, seasonality and whether the patient was admitted from an institution or not. RESULTS: In total, 1756 patients were included in the study. 30-day-mortality and in-hospital mortality were lower (OR = 0.48, p = 0.003 and OR = 0.46, p = 0.001) in the guideline adherent group, compared to the non-adherent group. Adherence to guideline did not affect 30-day readmission. In linear regression analysis there was a trend towards shorter LOS when LOS was analysed for patients discharged alive (predicted mean difference − 0.47, 95% CI (− 1.02, 0.07), p = 0.081). In competing risk analysis of LOS, the adherent group had a subdistribution hazard ratio (SHR) of 1.17 95% CI (1.02, 1.34), p = 0.025 for discharge compared to the non-adherent group. CONCLUSIONS: Adhering to antibiotic guidelines when treating infections in hospital inpatients was associated with favourable patient outcomes in terms of mortality and LOS. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13756-019-0515-5) contains supplementary material, which is available to authorized users. BioMed Central 2019-04-15 /pmc/articles/PMC6466722/ /pubmed/31011417 http://dx.doi.org/10.1186/s13756-019-0515-5 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Wathne, Jannicke Slettli
Harthug, Stig
Kleppe, Lars Kåre Selland
Blix, Hege Salvesen
Nilsen, Roy M.
Charani, Esmita
Smith, Ingrid
The association between adherence to national antibiotic guidelines and mortality, readmission and length of stay in hospital inpatients: results from a Norwegian multicentre, observational cohort study
title The association between adherence to national antibiotic guidelines and mortality, readmission and length of stay in hospital inpatients: results from a Norwegian multicentre, observational cohort study
title_full The association between adherence to national antibiotic guidelines and mortality, readmission and length of stay in hospital inpatients: results from a Norwegian multicentre, observational cohort study
title_fullStr The association between adherence to national antibiotic guidelines and mortality, readmission and length of stay in hospital inpatients: results from a Norwegian multicentre, observational cohort study
title_full_unstemmed The association between adherence to national antibiotic guidelines and mortality, readmission and length of stay in hospital inpatients: results from a Norwegian multicentre, observational cohort study
title_short The association between adherence to national antibiotic guidelines and mortality, readmission and length of stay in hospital inpatients: results from a Norwegian multicentre, observational cohort study
title_sort association between adherence to national antibiotic guidelines and mortality, readmission and length of stay in hospital inpatients: results from a norwegian multicentre, observational cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466722/
https://www.ncbi.nlm.nih.gov/pubmed/31011417
http://dx.doi.org/10.1186/s13756-019-0515-5
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