Misty Pratt

Common antibiotics carry small but serious risks of life-threatening drug reactions: Study

Christopher.Sorensen — Wed, 14 Aug 2024 12:51:57 +0000

Common antibiotics carry small but serious risks of life-threatening drug reactions: Study

Christopher.Sorensen Wed, 08/14/2024 - 08:51

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(photo by vorDa/Getty Images)

Misty Pratt

Topic

Breaking Research

Sunnybrook Health Sciences

Temerty Faculty of Medicine

Research & Innovation

Subheadline

Researchers say physicians should consider prescribing lower-risk antibiotics for patients when clinically appropriate

Two classes of commonly prescribed oral antibiotics are associated with the greatest risk for severe drug rashes that can lead to emergency department visits, hospitalizations and even death, according to a study by researchers at ICES, Sunnybrook Research Institute and the University of Toronto.

The study, published in the journal JAMA, found that sulfonamides (“sulfa drugs”) and cephalosporins were associated with the highest risk of reactions. The findings were based on a case-control study that used health-care data from ICES of adults 66 years or older who received a prescription for at least one oral antibiotic between 2002 and 2022 in Ontario.

Serious cutaneous adverse drug reactions (cADRs), or severe drug rash, are a group of rare but potentially life-threatening delayed reactions involving the skin and, often, internal organs. Some of these reactions carry mortality rates from 20 to 40 per cent. While many different classes of drugs can cause serious reactions, antibiotics are among the most commonly reported triggers.

The researchers say physicians should consider prescribing lower-risk antibiotics for patients when clinically appropriate.

“Clinicians have speculated that certain antibiotics carry greater risk for these severe reactions, but no study has ever confirmed these claims,” says Erika Lee, an allergist and a trainee with ICES and the Temerty Faculty of Medicine’s Eliot Phillipson Clinician-Scientist Training Program.

“Our objective was to explore the risk for cADRs in a population of older adults, who tend to receive disproportionately more antibiotic prescriptions than younger adults.”

Over the study period, 21,758 adults had an emergency department visit or hospitalization for a serious reaction following oral antibiotics and were matched with 87,025 controls who did not have a reaction.

“The good news is that most patients who visited the hospital with these reactions were discharged without being admitted, so that should be reassuring to providers and patients,” says Lee. “However, of those who were admitted to hospital with the most severe reactions, 20 per cent were treated in the ICU and five per cent of hospitalized patients died, which underscores the need for careful prescribing practices.”

The most commonly prescribed antibiotics were penicillins (29 per cent), followed by cephalosporins (18 per cent), fluoroquinolones (17 per cent), macrolides (15 per cent) nitrofurantoin (nine per cent) and sulfonamides (six per cent). Less commonly prescribed antibiotics were grouped together and accounted for seven per cent of prescriptions.

Other key findings include:

There were two antibiotic reaction-related hospital visits for every 1,000 antibiotic prescriptions dispensed
About one in eight patients who arrived at the emergency department with antibiotic-related reactions were hospitalized, likely because their reactions were more severe or because of concerns about potential complications
Twenty per cent of hospitalized patients with the most severe forms of reactions were treated in a critical care unit, and five per cent of those patients died

“While rare, these severe drug reactions can be life-threatening. Patients should be aware of rash, fever and other symptoms, which can start weeks after a prescription has been started and even after the course of antibiotics has stopped,” says David Juurlink, a staff internist and head of the division of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre, senior core scientist with ICES and professor in the department of medicine in the Temerty Faculty of Medicine.

“It’s also one more reason why antibiotics should be prescribed only when they’re truly needed.”

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Hospitals with higher ratio of female surgeons, anaesthetists have better patient outcomes: Study

Christopher.Sorensen — Wed, 22 May 2024 14:48:30 +0000

Hospitals with higher ratio of female surgeons, anaesthetists have better patient outcomes: Study

Christopher.Sorensen Wed, 05/22/2024 - 10:48

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Reaching a critical mass of more than 35 per cent female anesthesiologists and surgeons was linked to lower odds of severe post-operative complications, according to a study from ICES, Sunnybrook Research Institute and U of T (photo by Shannon Fagan/Getty Images)

Misty Pratt

Topic

Breaking Research

Sunnybrook Health Sciences Centre

Temerty Faculty of Medicine

Research & Innovation

University Health Network

Subheadline

"These results are the start of an important shift in understanding the way in which diversity contributes to better quality care around the time of surgery"

Greater sex diversity in hospital anaesthesia-surgery teams is associated with better post-operative outcomes for patients, according to a study from ICES, Sunnybrook Research Institute and the University of Toronto.

The study, published in the British Journal of Surgery, found that teams with more than 35 per cent female anesthesiologists and surgeons were associated with a three per cent reduction in odds of post-operative complications in the three months following surgery.

This is one of the first studies to focus on sex diversity of operating room teams, building on past work that has compared the impact of individual surgeon and anesthesiologist characteristics on patient outcomes.

“We wanted to challenge the binary approach of comparing female and male clinicians and rather highlight the importance of diversity as a team asset or bonus in enhancing quality care,” says lead author Julie Hallet, a scientist with ICES and Sunnybrook Research Institute, and associate professor of surgery at U of T’s Temerty Faculty of Medicine.

The study includes population-based, health-care data on 709,899 adult patients undergoing major in-patient surgeries in Ontario between 2009 and 2019.

Sex diversity of surgical teams was defined as the percentage of female anesthesiologists and surgeons among all anesthesiologists and surgeons working in the hospital each year. The primary outcome was 90-day major morbidity, which the researchers analyzed with a standardized classification scale to identify severe post-surgical complications.

The findings showed that reaching a critical mass of more than 35 per cent female anesthesiologists and surgeons was linked to lower odds of severe complications.

The association between greater sex diversity and reduced post-surgical complications was even greater for patients treated by female anesthesiologists and female surgeons – which aligns with previous studies comparing outcomes of male to female surgeons.

“These results are the start of an important shift in understanding the way in which diversity contributes to better quality care around the time of surgery,” says Hallet. “Ensuring a critical mass of female anesthesiologists and surgeons in operative teams is crucial to performance. Below a critical mass, female clinicians may withhold their perspectives, such that the benefits of diversity can only be achieved once minimum representation is reached.”

One limitation of the study is that the data did not include gender as a social construct. It is possible that gender roles, behaviours and attitudes would have influenced the strength of the association.

The study’s authors noted further research is also needed to explore diversity based on other sociodemographic variables, including but not limited to race and ethnicity.

Nevertheless, this study is the first to show a robust positive association between team sex diversity, patient outcomes and quality care.

“We hope that these results will encourage hospitals to intentionally foster sex diversity in operating room teams to reduce poor health outcomes, which, in turn, can improve patient satisfaction and promote sustainability of health systems,” says Gianni Lorello, staff anesthesiologist at Toronto Western Hospital, University Health Network and an associate professor in Temerty Medicine’s department of anesthesiology and pain medicine.

“Ensuring sex diversity in operative teams will require intentional effort for recruitment and retainment policies for female physicians, structural interventions such as minimum representation on teams, and monitoring and reporting of teams’ composition to build institutional accountability in existing systems.”

The research was supported by the Sunnybrook Alternate Funding Plan Innovation Fund.

Patients operated on by female surgeons had lower health-care costs: Study

Christopher.Sorensen — Fri, 01 Dec 2023 16:18:45 +0000

Patients operated on by female surgeons had lower health-care costs: Study

Christopher.Sorensen Fri, 12/01/2023 - 11:18

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(photo by Chris Ryan/Getty Images)

Topic

Breaking Research

Sinai Health

Sunnybrook Health Sciences

Temerty Faculty of Medicine

Research & Innovation

University Health Network

A new study suggests that patients treated by female surgeons, across many different types of procedures, have lower total health-care costs than patients treated by male surgeons.

The population-based cohort study, published in JAMA Surgery, included over one million adult patients in Ontario who were undergoing 25 common elective and emergency surgeries between 2007 and 2019. The health and demographics data were linked and analyzed at ICES, an independent, non-profit research institute.

Prior studies have also found that patients treated by female physicians have better health outcomes than those treated by male physicians when it comes to mortality, surgical complications, re-operations and readmission to hospital after the surgery.

"It could be that managing potential complications following surgery will contribute to greater costs for male surgeons," says lead author Christopher Wallis, a urologic oncologist at Sinai Health and University Health Network who is an assistant professor in the University of Toronto’s department of surgery in the Temerty Faculty of Medicine.

Researchers Angela Jerath and Christopher Wallis (supplied image)

Costs for female surgeons were significantly lower at 30 days, 90 days and one year following surgery compared to those treated by male surgeons, according to the study. This corresponds to a relative cost difference of 10 percent.

"These differences represent potentially large savings for the health-care system," says Angela Jerath, a scientist at Sunnybrook Research Institute and adjunct scientist at ICES who is an associate professor in Temerty Medicine’s department of anesthesiology and pain medicine. "We need further qualitative research to better understand behavioural and sociocultural factors that may underpin these cost differences."

"There's also a need to improve recruitment and retention of female surgeons, as evidence shows dwindling numbers the higher up you go in surgical departments," adds Wallis.

"Creating more equitable and inclusive working environments would contribute to greater diversity and could have a positive impact on the health of patients undergoing surgery."

The study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. It was also supported by U of T’s Data Sciences Institute, an institutional strategic initiative.

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Misty Pratt