Patient-reported experience measures in deprescribing for hospitalised older patients: a prospective, multicentre, observational study.

BACKGROUND: Hospitalisation provides an opportunity for medication review and deprescribing. Patient-reported experience measures (PREM) for deprescribing in older patients in hospital are not well described. AIMS: To pilot test and describe PREM for deprescribing in older patients, compare PREM by patient characteristics and investigate patients' awareness of medication changes on hospital discharge. METHODS: This prospective, multicentre, observational cohort study at two tertiary hospitals in Sydney, Australia, evaluated the PREM questionnaire developed by the NSW Therapeutic Advisory Group. It was completed by patients (or their next of kin) recruited from acute geriatric medicine and orthogeriatric services. Association with nine patient characteristics was analysed using the Chi-squared test and multivariable regression. Awareness of medication changes and test-retest reliability were analysed using descriptive statistics. RESULTS: Overall, 201 participants completed the questionnaire, with 170 eligible for analysis; 34 (20%) of 170 were aware of reduction or cessation of their usual medications on discharge and reported involvement in decision-making and receiving enough information to reduce or stop one or more of their usual medications (positive PREM). Independent predictors of positive PREM included respondent (next of kin), hospital (Hospital 1), language (English) and specialty (acute geriatric medicine). Overall, 92 (59.4%) of 155 patients with medication changes were aware of those changes on hospital discharge. CONCLUSIONS: These PREM are a feasible tool to examine older patients' experiences of deprescribing in hospital and might be applied to evaluate interventions to improve awareness, shared decision-making and provision of information when deprescribing for older patients.

Carbapenem sparing in the management of post-transrectal prostate biopsy bacteraemia.

BACKGROUND: Sepsis following transrectal ultrasound (TRUS)-guided prostate biopsy is a major complication. With the emergence of multidrug-resistant organisms, empirical use of carbapenem antibiotics has been increasing. This study, conducted in the Illawarra Shoalhaven Local Health District (ISLHD), Australia, quantifies how much we can spare carbapenem use. METHODS: A retrospective audit of patients who underwent TRUS prostate biopsy and were admitted post-operatively with proven bacteraemia between January 2007 and April 2016. RESULTS: Of 2719 TRUS procedures, 50 (1.84%) cases had bacteraemia. The most common isolate was Escherichia coli in 44 of 50 (88%) of which six of 50 (12%) were extended-spectrum beta-lactamase (ESBL)-producing. Sixteen different empirical antimicrobial regimens were used, to which 42 of 50 (84%) of isolates were susceptible. Eight (16%) isolates were resistant to the chosen empiric combination, with five switched over to appropriate treatment once antimicrobial sensitivity results became available. Empirical carbapenem was utilized in 12 of 50 (24%) patients with only two of the ESBL isolates covered. A further 10 of 50 patients received carbapenems during their admission. Carbapenems could have been avoided in 18 of 22 (82%). A total of 86% of organisms (n = 43) were susceptible to the combination of amoxicillin-clavulanate and gentamicin. CONCLUSION: Although the rates of bacteraemia with ESBL-producing organisms post-TRUS biopsy are increasing, use of carbapenem-free combination antimicrobials as empirical therapy appears to be safe and effective in our setting. Clinicians can utilize local resistance patterns to inform targeted and appropriate therapy for septic patients.