Background and Importance Antibiotics are some of the most prescribed drugs at the Emergency Department (ED) and it is usually inappropriate. An educational intervention by the antimicrobial stewardship programme (ASP) could be effective to improve the use of antibiotics.
Aim and Objectives To compare and analyse the interventions carried out on empirical antibiotic prescription (EAP) in two periods at ED by the multidisciplinary ASP(MASP). To compare defined daily doses per 100 discharges (DDD/100D) of meropenem in both periods.
Material and Methods Quasi-experimental study was conducted to compare the interventions performed by the MASP (formed by infectious disease doctors, clinical pharmacists and microbiologists) at ED of a tertiary hospital during June-2019(first period, FP) and March-2021(second period, SP). Unique recommendations on the adequacy of EAP were made for each patient and antibiotic dose optimisation. Collected data included patient demographics, diagnosis, prescription and its adequacy, recommendations made and grade of acceptance. Meropenem consumption of hospitalised patients during the intervention period and following month was obtained through the drug record programme in order to calculate the DDD/100D.
A database was created in Excel and analysed with SPSSv17.0 statistical software.
Results 145 patients were included: 58.6% men, mean age 71.2 years (SD:17.4). 42 on FP group (FPG) and 103 on SP group (SPG).
Over all the prescriptions, 58.6%(80/145) were appropriate, 50%(21/42) in FPG and 57.3%(59/103) in SPG. When inadequate prescription:
Global acceptance was 95.9% (139/145), being 95.9% (40/42) in FPG and 96.1% (99/103) in SPG.
The most prescribed antibiotic was ceftriaxone (49/145), followed by amoxicillin/clavulanate (26/145) and piperacillin/tazobactam (25/145).
The EAP of meropenem was 26.2% (11/42) in FPG and 6.8% (7/103) in SPG with statistically significant differences (p<0.002).
DDD/100D of meropenem was 27.9 in FPG and 22.9 in SPG.
Conclusion and Relevance An improvement in EAP has been observed. Although the acceptance rate in both periods was very high, the results show that more work needs to be done on training of prescribers.
Having stablished the MASP at EM has led to significant decrease of empirical meropenem use. This may have contributed to reduce DDD/100D of it in our hospital.
Conflict of Interest No conflict of interest