Antimicrobial stewardship in diabetic ketoacidosis: a single centre experience

Gassiep, Ian, Bachmeier, Caroline, Hendry, Stephanie, Emeto, Theophilus I., Armstrong, Mark, Sangla, Kunwarjit, and Heather, Christopher S. (2019) Antimicrobial stewardship in diabetic ketoacidosis: a single centre experience. Internal Medicine Journal. (In Press)

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Abstract

Background: Diabetic ketoacidosis (DKA) is a common and serious complication arising predominantly in patients with type 1 diabetes mellitus (T1DM). International data demonstrate that infection is one of the most common precipitating causes of DKA. Currently there is limited data regarding the role of antimicrobial stewardship (AMS) in this setting.

Aim: The aim of this study is to provide epidemiologic data regarding infections precipitating DKA, microbiological aetiology, and antimicrobial prescribing practices, in order to inform AMS interventions.

Methods: Retrospective chart review of all T1DM DKA presentations from May 2015 – June 2018.

Results: In total 249 DKA presentations occurred in 111 patients. Suspected infection accounted for 100/249 (40%) presentations. Only 36/249 (14.5%) were proven or probable infections on review. Of 80 antimicrobial prescriptions, 75% were inappropriate based on guideline management of suspected infection. Neutrophilia was not a statistically significant indicator of infection (p = 0.78). Presence of elevated CRP had the greatest association with infection, OR: 10.1 (95% CI, 1.05 to 97.0). Lymphopenia demonstrated increased likelihood of infection, OR: 3.1 (95% CI, 1.14 to 8.2). Interestingly, thrombocytosis appeared to be associated with a decreased likelihood of infection, OR: 0.31 (95% CI, 0.105 to 0.903).

Conclusion: This study demonstrates a lower incidence of infection compared to most previous publications, and suggests that infection‐precipitated DKA may be over reported. Furthermore, our findings provide support for the role of AMS in the management of DKA.

Item ID: 60358
Item Type: Article (Research - C1)
ISSN: 1445-5994
Keywords: antimicrobial stewardship; diabetic ketoacidosis; bacterial infection; inappropriate prescribing; emergency medicine
Date Deposited: 10 Oct 2019 02:33
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110305 Emergency Medicine @ 30%
11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110303 Clinical Microbiology @ 40%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 30%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 25%
92 HEALTH > 9202 Health and Support Services > 920203 Diagnostic Methods @ 25%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920106 Endocrine Organs and Diseases (excl. Diabetes) @ 50%
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