Background and importance Inappropriate prescription of antimicrobials has been shown to be a cause of microbial resistance. Antibiotics are some of the most prescribed drugs in the emergency department (ED). An educational intervention by a multidisciplinary group could be effective to improve the use of these drugs.
Aim and objectives To describe the current appropriateness of antibiotic prescription in the observation unit of the ED, and the first results of a multidisciplinary antimicrobial stewardship programme (ASP).
Material and methods A pilot interventional study over 1 month was designed. An ASP was organised, comprising an infectious diseases physician, clinical pharmacist and microbiologist. The goal was to attend the ED daily and to assess antimicrobial treatments, interacting directly with physicians and providing oral and written education according to the protocols approved by the centre.
The data collected included patient demographics, diagnosis and antimicrobial prescribed (dose, route, duration), appropriateness of the prescription, recommendations made and its rate of acceptance.
Results Sixty-four patients were included: 65.6% men, mean age 70.2 (SD 17.4) years, 4.6% allergic to beta-lactams and 17.2% from a nursing home. The most common diagnoses were community acquired pneumonia (17.2%), respiratory tract infections (15.6%) and urinary tract infections (15.6%); 84.4% of patients were hospitalised. The empirical antimicrobials most prescribed were meropenem (28.1%), levofloxacin (17.2%) and amoxicillin–clavulanic (15.6%).
In 84.4%, patients were asked for cultures before starting antibiotic therapy. Inappropriate prescriptions according to the protocol accounted for 48.4%. Of these, 45% were excessive (either on spectrum or dose), 32% were insufficient and 22% were given to patients that had no infection.
We made 80 recommendations: 41.0% to continue treatment, 18.6% to discontinue treatment, 18.6% to decrease the spectrum, 13.8% to increase the spectrum, 5.0% to change to the oral route and 2.5% to decrease the dose. The acceptance rate was 93.8%.
Conclusion and relevance Even though a high ratio of prescriptions were considered inappropriate, a large percentage of the recommendations were accepted, which shows that our intervention was well received by the clinical staff. This could be explained by the involvement of a multidisciplinary group and direct interaction with physicians. Such an educational approach might be highly effective in improving future antibiotic prescriptions in the ED.
References and/or acknowledgements No conflict of interest.
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