Appropriateness of antibiotic prescribing for patients with sepsis in rural hospital emergency departments

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Heffernan, AJ
Smedley, A
Stickley, T
Oomen, S
Carrigan, B
Heffernan, R
Woodall, H
Pinidiyapathirage, J
Brumpton, K
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Design/Participants This was a multicentre retrospective cohort study of adult patients (≥18 years) presenting with a process associated International Classification of Diseases code (ICD-AM-10) pertaining to sepsis between January 2017 and July 2020 to rural Emergency Departments.

Main Outcome Measures Our primary outcome was antibiotic appropriateness as defined by the Australian Therapeutic Guidelines (for antibiotic selection relative to infecting source) and the National Antimicrobial Prescribing Survey tool. Our secondary outcome was in-hospital mortality.

Methods Relevant clinical and non-clinical, physiological and laboratory data were collected retrospectively. Multivariate logistic regression was used to estimate the odds of both inappropriate antibiotic prescribing and in-hospital mortality based on clinical and non-clinical factors.

Results A total of 378 patients were included who primarily presented with sepsis of unknown origin (36.8%), a genitourinary (22.22%) or respiratory (18.78%) source. Antibiotics were appropriately prescribed in 59% of patients. A positive Quick Sequential Organ Failure Assessment score (qSOFA) (odds ratio [OR] = 0.49; 95% confidence interval [CI], 0.29–0.83), a respiratory infection source (OR = 0.5; 95% CI, 0.29–0.86) and documented allergy (OR = 0.42; 95% CI, 0.25–0.72) were associated with a lower risk of appropriate prescribing in multivariate analysis. Forty-one percent of patients received antibiotics within 1 h of presentation. Inappropriate antibiotic prescribing was not associated with in-hospital mortality.

Conclusion The rates of appropriate antibiotic prescribing in rural Emergency Departments for patients presenting with sepsis is low, but comparable to other referral metropolitan centres.

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Australian Journal of Rural Health

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© 2023 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Heffernan, AJ; Smedley, A; Stickley, T; Oomen, S; Carrigan, B; Heffernan, R; Woodall, H; Pinidiyapathirage, J; Brumpton, K, Appropriateness of antibiotic prescribing for patients with sepsis in rural hospital emergency departments, Australian Journal of Rural Health, 2023