Adherence to guideline-based antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease in an Australian tertiary hospital

Fanning, M., McKean, M., Seymour, K., Pillans, P. and Scott, I. (2014) Adherence to guideline-based antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease in an Australian tertiary hospital. Internal Medicine Journal, 44 9: 903-910. doi:10.1111/imj.12516

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Author Fanning, M.
McKean, M.
Seymour, K.
Pillans, P.
Scott, I.
Title Adherence to guideline-based antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease in an Australian tertiary hospital
Journal name Internal Medicine Journal   Check publisher's open access policy
ISSN 1444-0903
1445-5994
Publication date 2014-09-01
Year available 2014
Sub-type Article (original research)
DOI 10.1111/imj.12516
Open Access Status
Volume 44
Issue 9
Start page 903
End page 910
Total pages 8
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell
Language eng
Formatted abstract
Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are an important cause of acute hospital admissions and incur significant costs, which include antibiotic costs.

Aims: This study aimed to (i) define antibiotic prescribing practice in patients admitted to a tertiary hospital with AECOPD and compare this with current locally and nationally recognised antibiotic prescribing guidelines and (ii) correlate variations in guideline-concordant antibiotic prescribing with mean length of stay (LOS) and rates of unplanned readmission to hospital.

Methods: Retrospective case series of 84 consecutive patients with uncomplicated AECOPD who met pre-specified selection criteria.

Results: Seventy-two of 84 participants (85.7%) received guideline-discordant antibiotics, of whom the majority (76%) received intravenous antibiotics. Mean LOS was significantly lower among patients receiving guideline-concordant therapy compared with those receiving guideline-discordant therapy (mean 1.6 days vs 3.7 days; P = 0.002). There was no significant difference between groups in rates of readmission. Estimated excess costs per patient associated with guideline-discordant therapy equalled $2642 which, if eliminated, would save approximately $300 000 per annum.

Conclusion: In a tertiary hospital, Australian guidelines for treating patients with an AECOPD were rarely followed. The use of guideline-discordant therapy resulted in longer hospital stays and incurred greater costs. Studies are required to determine the reasons behind such discordant practice and to develop initiatives to improve antibiotic prescribing.
Keyword Pulmonary disease
Chronic obstructive
Antibacterial agent
Guideline adherence
Hospital
Outcomes assessment
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
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