Unnecessary antibiotic use in patients with asthma may increase hospital stay, cost
Patients who have been hospitalized because of an asthma exacerbation and are given antibiotics do not experience better short-term outcomes than those who do not receive antibiotic treatment, according to findings presented at the American Thoracic Society International Conference.
“Our results strengthen the evidence that antibiotics should not be prescribed routinely in adult patients hospitalized with asthma,” Mihaela S. Stefan, MD, PhD, physician at Baystate Medical Center, research scientist at the Institute for Healthcare Delivery and Population Science, and associate professor at the University of Massachusetts Medical School, told Infectious Disease News.
Stefan and colleagues conducted a retrospective cohort study of 22,043 adult patients aged older than 18 years from 554 hospitals across the United States who presented with an asthma exacerbation and were treated with systemic corticosteroids between Jan. 1, 2015, and Dec. 31, 2016. Patients were excluded if they were diagnosed with any condition requiring antibiotic treatment — including pneumonia — started on mechanical ventilation or admitted to an ICU within 2 days of hospitalization, according to the presentation. Study outcomes included length of stay, antibiotic-related diarrhea occurrence and treatment failure, as defined by initiation of mechanical ventilation or transfer to an ICU after hospital day 2, in-hospital mortality and/or readmission for asthma within 30 days of discharge.
According to the presentation, 46.1% of patients were treated with antibiotics within the first 2 days of hospital admission. Researchers observed that patients who received antibiotics were older than those who did not, and the mean age of antibiotic-treated patients was 50.5 years. Furthermore, when comparing the two groups, those who were treated with antibiotics were predominantly white (49.6% vs. 41.5%), more likely to smoke (7.6% vs. 5.5%) and experienced a higher burden of comorbidities.
The mean hospital stay of patients treated with antibiotics was 4.4 days, which Stefan and colleagues observed was longer than that of patients who did not receive antibiotics (mean hospital stay, 3.4 days; P = .001). However, researchers said the treatment failure rate was similar, with a 5.56% failure rate among patients receiving antibiotics and a 5.64% failure rate among patients who were not treated with antibiotics (P = .001). When patient outcomes were evaluated in a propensity matched analysis, antibiotic treatment was associated with a longer hospital stay (RR = 1.27; 95% CI, 1.25-1.29), higher hospitalization costs (mean costs, $6,427 vs. $5,387) and an increased risk of antibiotic-related diarrhea (OR = 1.55; 95% CI, 1.16-2.08), although an increased risk for treatment failure was not observed (OR = 1.02; 95% CI, 0.88-1.17), according to the researchers.
Stefan and colleagues found that antibiotic treatment, in addition to steroids, did not create significantly better short-term outcomes for patients hospitalized with an asthma exacerbation without any lung infection. The study suggests the need for reduced antibiotic use in patients with asthma to decrease bacterial resistance and antibiotic overuse.
“The ID clinicians, as stewards of antibiotic utilization in the hospital, should persuade hospital and emergency physicians to follow the guidelines and avoid antibiotic prescribing in patients with asthma,” Stefan said in the interview. – by Marley Ghizzone
Stefan M, et al. Abstract A7763/P46. Presented at: American Thoracic Society International Conference; May 18-23, 2018; San Diego.
Disclosure: Stefan reports no relevant financial disclosures.