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Association between antibiotics and rehospitalization in patients with acute exacerbations of chronic obstructive pulmonary disease discharged from the emergency department

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Abstract

Background

Patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are frequently discharged from the emergency department (ED) and treated with antibiotics. The role of antibiotics in the outpatient management of AECOPD is controversial and has never been studied in the ED setting.

Methods

We conducted a secondary analysis of prospectively collected data from the validation study of the Ottawa COPD Risk Scale. We included adult patients with AECOPD who were discharged from six tertiary care EDs in Canada over a two-year period and assessed rates of rehospitalization within 14 days of ED discharge. To examine the association between antibiotic treatment and rehospitalization, we performed multivariable logistic regression and propensity score-matched analyses.

Results

A total of 774 patients were included in the analysis. The mean age was 69.4 years, 388 patients (50.1%) were female, and 451 patients (58.3%) were discharged with antibiotics. Twenty-nine (6.4%) and 36 (11.1%) patients returned to hospital with admission in the antibiotic and no antibiotic groups, respectively (unadjusted OR 0.55; 95% CI 0.33–0.92); adjustment for prespecified baseline characteristics using logistic regression yielded OR 0.65; 95% CI 0.38–1.08. In the propensity score-matched analysis comprising of 197 matched pairs, 15 (7.6%) and 19 patients (9.6%) in the antibiotic and no antibiotic groups returned with admission, respectively (OR 0.69; 95% CI 0.29–1.62).

Conclusion

For patients with AECOPD discharged from the ED, we did not find an association between outpatient treatment with antibiotics and lower rates of rehospitalization after accounting for differences in baseline patient characteristics. However, the small sample size and low observed rate of the primary outcome created substantial risk of Type II error. Until further evidence is available, clinicians should continue prescribing antibiotics for patients with AECOPD based on clinical judgement and current practice guidelines.

Résumé

Contexte

Les patients présentant des exacerbations aiguës de maladie pulmonaire obstructive chronique (EAMPOC) sont fréquemment renvoyés du service des urgences (SU) et traités avec des antibiotiques. Le rôle des antibiotiques dans la prise en charge ambulatoire de l’EAMPOC est controversé et n'a jamais été étudié dans le cadre des urgences.

Méthodes

Nous avons effectué une analyse secondaire des données recueillies prospectivement dans le cadre de l'étude de validation de l'échelle de risque de MPOC d'Ottawa. Nous avons inclus des patients adultes atteints d'EAMPOC qui sont sortis de six urgences de soins tertiaires au Canada sur une période de deux ans et avons évalué les taux de réhospitalisation dans les 14 jours suivant la sortie des urgences. Pour examiner l'association entre le traitement antibiotique et la réhospitalisation, nous avons effectué une régression logistique multivariable et des analyses par appariement de score de propension.

Résultats

Un total de 774 patients a été inclus dans l'analyse. L'âge moyen était de 69,4 ans, 388 patients (50,1 %) étaient des femmes et 451 patients (58,3 %) sont sortis avec des antibiotiques. Vingt-neuf (6,4 %) et 36 (11,1 %) patients sont retournés à l'hôpital avec admission dans les groupes avec et sans antibiotique, respectivement (OR non ajusté 0,55 ; IC à 95 % 0,33 à 0,92) ; l'ajustement pour les caractéristiques de base préspécifiées à l'aide de la régression logistique a donné un OR de 0,65 ; IC à 95 % 0,38 à 1,08. Dans l'analyse appariée par score de propension comprenant 197 paires appariées, 15 (7,6 %) et 19 (9,6 %) patients des groupes avec et sans antibiotique sont revenus avec une admission, respectivement (OR 0,69 ; IC 95 % 0,29 à 1,62).

Conclusion

Pour les patients atteints d'AECOPD sortis des urgences, nous n'avons pas trouvé d'association entre le traitement ambulatoire par antibiotiques et des taux plus faibles de réhospitalisation après avoir pris en compte les différences dans les caractéristiques de base des patients. Toutefois, la petite taille de l’échantillon et le faible taux observé du résultat principal ont créé un risque important d’erreur de type II. Jusqu'à ce que d'autres preuves soient disponibles, les cliniciens doivent continuer à prescrire des antibiotiques aux patients atteints d'AECOPD en se basant sur le jugement clinique et les directives de pratique actuelles.

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Authors and Affiliations

  1. Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada

    Bo Zheng & Brian H. Rowe

  2. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

    Bo Zheng, Monica Taljaard & Ian G. Stiell

  3. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Monica Taljaard, Shawn D. Aaron, Krishan Yadav & Ian G. Stiell

  4. Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Shawn D. Aaron

  5. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada

    Krishan Yadav & Ian G. Stiell

  6. School of Public Health, University of Alberta, Edmonton, AB, Canada

    Brian H. Rowe

  7. Division of Respirology, Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Chrystal Chan

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  1. Bo Zheng
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Correspondence to Bo Zheng.

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Zheng, B., Taljaard, M., Aaron, S.D. et al. Association between antibiotics and rehospitalization in patients with acute exacerbations of chronic obstructive pulmonary disease discharged from the emergency department. Can J Emerg Med 24, 725–734 (2022). https://doi.org/10.1007/s43678-022-00373-2

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  • DOI: https://doi.org/10.1007/s43678-022-00373-2

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