Antibiotic-associated diarrhoea in emergency department observation unit patients.

Clostridium difficile diarrhoea is an urgent threat to patients, but little is known about the role of antibiotic administration that starts in emergency department observation units (EDOUs). We studied risk factors for antibiotic-associated diarrhoea (AAD) and C. difficile infection (CDI) in EDOU patients. This prospective cohort study enrolled adult patients discharged after EDOU antibiotic treatment between January 2013 and 2014. We obtained medical histories, EDOU treatment and occurrence of AAD and CDI over 28 days after discharge. We enrolled and followed 275 patients treated with antibiotics in the EDOU. We found that 52 (18·6%) developed AAD and four (1·5%) had CDI. Patients treated with vancomycin [relative risk (RR) 0·52, 95% confidence interval (CI) 0·3-0·9] were less likely to develop AAD. History of developing diarrhoea with antibiotics (RR 3·11, 95% CI 1·92-5·03) and currently failing antibiotics (RR 1·90, 95% CI 1·14-3·16) were also predictors of AAD. Patients with CDI were likely to be treated with clindamycin. In conclusion, AAD occurred in almost 20% of EDOU patients with risk factors including a previous history of diarrhoea with antibiotics and prior antibiotic therapy, while the risk of AAD was lower in patients receiving treatment regimens utilizing intravenous vancomycin.

Hospitalized low-risk community-acquired pneumonia: outcome and potential for cost-savings.

OBJECTIVE: In the USA, a group of low-risk patients with community-acquired pneumonia (CAP) with a low risk of mortality were identified and it was suggested that they may be treated as outpatients to save costs. We evaluated the outcome of these low-risk CAP patients that were hospitalized in our local setting, and gauged the number of such patients in order to estimate the potential cost-savings by treating them as out-patients, as well as the safety of such an approach. METHODOLOGY: All patients with CAP admitted to the National University Hospital, Singapore, from 1 April to 1 November 1997 were enrolled into a prospective cohort study. Low-risk patients were identified, and their hospital outcomes were compared with the other patients. Hospitalization charges were obtained from the Finance Department. RESULTS: There were 155 CAP patients (69 females and 86 males). The age was 56.6 +/- 22.2 years, ranging from 12 to 93 years old. The average hospital stay was 8.4 +/- 11 days. Mortality was 12.9%. There were 37 (24%) low-risk CAP patients, and there was no mortality in this group. No low-risk patient required mechanical ventilation. They had a significantly shorter hospital stay compared with high-risk patients. An identifiable organism was found in 27% of the low-risk CAP with only one patient having a positive blood culture. The average hospitalization charge for low-risk CAP patients was, as expected, significantly lower than for the high-risk patients, and was 11.9% of the total cost for hospitalized CAP patients. CONCLUSION: Nearly one-quarter of our CAP admissions consisted of low-risk patients that had no mortality, and required a significantly shorter hospitalization period. The management of such patients who are young (< or = 50 years), and had no serious coexisting conditions in an out-patient setting, may lead to significant cost-savings as the average hospitalization charge was US$1295 and 11.9% of total hospitalization charges for CAP.