Emergency department visits for antibiotic-associated adverse events
Emergency department visits for antibiotic-associated adverse events
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DOI：
10.1086/591126
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发表时间：
2008-09-15
影响因子：
11.8
通讯作者：
Budnitz, Daniel S.
中科院分区：
文献类型：
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作者：
Shehab, Nadine;Patel, Priti R.;Budnitz, Daniel S.
背景药物相关不良事件是抗生素使用的一个未被充分认识的后果，这些事件的全国规模和范围尚未研究。我们的目的是估计和比较美国与全身抗生素相关的药物相关不良事件的急诊科（艾德）就诊的数量和比率，按药物类别、个体药物和事件类型进行。我们分析了国家电子伤害监测系统合作药物不良事件监测项目（2004-2006年）中的药物相关不良事件，以及全国门诊医疗实践抽样调查、全国门诊医疗调查和全国医院门诊医疗调查（2004-2005年）中的门诊处方。基于6614例病例，估计每年有142，505次（95%置信区间[CI]，116，506 - 168，504次访视）因全身抗生素引起的药物相关不良事件而前往美国ED。在所有艾德就诊的药物相关不良事件中，19.3%涉及抗生素。大多数艾德访视与过敏反应相关（78.7%的访视; 95% CI，75.3%-82.1%的访视）。估计的一半艾德访视归因于青霉素类（36.9%的访视; 95% CI，34.7%-39.2%的访视）和头孢菌素类（12.2%; 95% CI，10.9%-13.5%）。在常用抗生素中，磺胺类和克林霉素与艾德就诊率最高相关（18.9次艾德访视/10，000次门诊处方访视[95% CI，13.1-24.7次艾德访视/10，000次门诊处方访视]和18.5次艾德访视/10，000次门诊处方访视[95% CI，12.1-25.0艾德就诊/10，000次门诊处方就诊]）。与所有其他抗生素类别相比，磺胺类药物与中度至重度过敏反应的发生率显著较高相关（4.3% [95%CI，2.9%-5.8%] vs. 1.9%[95%CI，1.5%-2.3%]），磺胺类和氟喹诺酮类药物与神经系统或精神障碍的发生率显著较高相关（1.4% [95%CI，1.0%~ 1.7%] vs. 0.5% [95%CI，0.4%~ 0.6%]）。抗生素相关不良事件导致许多艾德就诊，过敏反应是最常见的事件。将不必要的抗生素使用减少到最低限度，即使是很小的百分比，也可以显着降低个体患者发生药物相关不良事件的直接和直接风险。
Background. Drug-related adverse events are an underappreciated consequence of antibiotic use, and the national magnitude and scope of these events have not been studied. Our objective was to estimate and compare the numbers and rates of emergency department (ED) visits for drug-related adverse events associated with systemic antibiotics in the United States by drug class, individual drug, and event type.Methods. We analyzed drug-related adverse events from the National Electronic Injury Surveillance System Cooperative Adverse Drug Event Surveillance project (2004-2006) and outpatient prescriptions from national sample surveys of ambulatory care practices, the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (2004-2005).Results. On the basis of 6614 cases, an estimated 142,505 visits (95% confidence interval [CI], 116,506-168,504 visits) annually were made to US EDs for drug-related adverse events attributable to systemic antibiotics. Antibiotics were implicated in 19.3% of all ED visits for drug-related adverse events. Most ED visits for antibiotic-associated adverse events were for allergic reactions (78.7% of visits; 95% CI, 75.3%-82.1% of visits). One-half of the estimated ED visits were attributable to penicillins (36.9% of visits; 95% CI, 34.7%-39.2% of visits) and cephalosporins (12.2%; 95% CI, 10.9%-13.5%). Among commonly prescribed antibiotics, sulfonamides and clindamycin were associated with the highest rate of ED visits (18.9 ED visits per 10,000 outpatient prescription visits [95% CI, 13.1-24.7 ED visits per 10,000 outpatient prescription visits] and 18.5 ED visits per 10,000 outpatient prescription visits [95% CI, 12.1-25.0 ED visits per 10,000 outpatient prescription visits], respectively). Compared with all other antibiotic classes, sulfonamides were associated with a significantly higher rate of moderate-to-severe allergic reactions (4.3% [95% CI, 2.9%-5.8%] vs. 1.9 % [95% CI, 1.5%-2.3%]), and sulfonamides and fluoroquinolones were associated with a significantly higher rate of neurologic or psychiatric disturbances (1.4% [95% CI, 1.0% 1.7%] vs. 0.5% [95% CI, 0.4%-0.6%]).Conclusions. Antibiotic-associated adverse events lead to many ED visits, and allergic reactions are the most common events. Minimizing unnecessary antibiotic use by even a small percentage could significantly reduce the immediate and direct risks of drug-related adverse events in individual patients.