Antimicrobial stewardship in diabetic ketoacidosis: a single centre experience
Journal Publication ResearchOnline@JCUAbstract
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.
Journal
Internal Medicine Journal
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Volume
50
ISBN/ISSN
1445-5994
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Pages Count
5
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Publisher
Wiley-Blackwell
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DOI
10.1111/imj.14335