Antibiotic therapy in the emergency room: Optimal prescription is indeed the best - 05/05/23
, F. Catherine b, B. Martha b, T. Sixt a, P. Chavanet a, M. Blot a, d, P. Ray c, L. Piroth a, dHighlights |
• | Antibiotic therapy prescriptions in Emergency Departments (EDs) are very frequent. |
• | Optimal prescriptions represent two thirds of the prescriptions in EDs. |
• | Compared to an optimal prescription, an adapted prescription in an ED is associated with a poorer prognosis. |
• | After reevaluation at D2, and when compared to an optimal prescription, an inadequate prescription is associated with a poorer prognosis. |
• | Optimal prescription is best for patient prognosis and should be encouraged in antibiotic stewardship. |
Abstract |
Introduction |
Emergency departments (ED) are pivotal for antibiotic prescription, of which the appropriateness and consequences have rarely been assessed.
Methods |
A retrospective study included patients referred to the ED and hospitalized with an advocated diagnosis of infection. Day-0 (ED initial prescription) and day-2 (reevaluation) antibiotic therapies were graded as optimal (if fully following the guidelines in terms of molecule, dose, and route of administration), adapted (if the prescribed molecule was microbiologically active but not recommended as first-line treatment, or in case of a wrong dose), or inadequate (other situations). The primary endpoint was onset of an unfavorable event (death, transfer to intensive care unit, or re-hospitalization). Prognosis factors associated with survival without unfavorable event were assessed by multivariate analysis.
Results |
We included 484 patients. Optimal, adapted, and inadequate initial prescriptions concerned 328 (67.8 %), 110 (22.7 %) and 46 (9.5 %) patients respectively. Compared with an optimal prescription, an initial adapted prescription was associated with a poorer prognosis (HR = 1.95, CI95% [1.18–3.22]; p = 0.01). Reevaluation was performed in 436 (90.1 %) patients. After reevaluation, optimal, adapted, and inadequate prescriptions concerned 326 (74.8 %), 64 (14.7 %), and 46 (10.5 %) patients respectively. After reevaluation, and as compared with optimal prescription, inadequate prescription was significantly associated with unfavorable events (HR = 3.52, CI95% [1.42–8.72]; p = 0.003).
Conclusion |
Antibiotics are frequently prescribed in EDs. Antibiotic prescription has got to be optimal, and not simply adapted, so as to be associated with significant clinical benefit.
Le texte complet de cet article est disponible en PDF.Keywords : Antibiotic therapy, Emergency departments, Prognosis, Appropriateness
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Vol 53 - N° 3
Article 104653- avril 2023 Retour au numéro
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