Antibiotic Associated adverse drug events very common in hospitalized patients.

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One in five hospitalized patients will experience adverse drug event (ADEs) reports a study published online June 12, 2017 in JAMA Internal Medicine.

The researchers looked at records of 1488 adult inpatients admitted at John Hopkins hospital between September 2013 and June 2014. The cohort received antibiotics for at least 24 hours for infectious indication.

Patients on antituberculous regimen or on topical or inhaled antibiotics were excluded from the study.

The researchers examined immediate adverse effects within 30 days of treatment or delayed effects consisting of Clostridium difficile infection (CDI) or incident multidrug-resistant organism infection(MDRO) at 90 days of starting the drugs.

The researchers looked at gastrointestinal, dermatologic, musculoskeletal, hematologic, hepatobiliary, renal, cardiac, and neurologic events.

The median age of patients was 59 years (interquartile range, 49-69 years) and nearly 50% were women. The median hospital stay was 4 days and the most common group of antibiotics were third-generation cephalosporins, parenteral vancomycin, and cefepime.

A total of 324 ADEs occurred overall; of which 186 (57%) happened within 30 days and 138 occurred within 90 days.

The most common ADEs were gastrointestinal, renal, and hematologic abnormalities. Of the 138 adverse events occurring with 90 days, 54 (39%) were cases of CDI and 84 (61%) were MDRO infections.

About 287 patients were receiving antibiotics regimen that was not clinically indicated. Furthermore, every 10 days of additional antibiotics increased the ADEs by 3%.

The authors acknowledge that their study has limitation because different hospitals have different antibiotic regimen in use, so the incidence of ADEs may vary. Also, the study did not include outpatients who are receiving broad spectrum antibiotics for long period of time.

“Unnecessary use of antibiotics is particularly concerning because antibiotics may be associated with a number of [adverse drug events (ADEs)] ... Estimates of the incidence of antibiotic-associated ADEs in hospitalized patients are generally unavailable,” Pranita D. Tamma, MD, MHS, from the division of pediatric infectious diseases at the Johns Hopkins University School of Medicine and colleagues wrote. “A comparative analysis of the incidence of ADEs across all classes of antibiotics has yet to be performed.”

“Our findings provide quantitative data about the risk of ADEs that clinicians should consider when weighing decisions to initiate or discontinue antibiotic therapy and lend further credence to the importance of antibiotic stewardship to optimize patient safety,” added Dr. Tamma.