Summary
Background
Antimicrobial stewardship programmes (ASPs) have been effective in optimizing antibiotic
use for inpatients. However, an emergency department's fast-paced clinical setting
can be challenging for a successful ASP.
Aim
In April 2015, an ASP was implemented in our emergency department and we aimed to
determine its impact on antimicrobial use for outpatients.
Methods
This was a single-centre study comparing the quality of antibiotic prescriptions between
a one-year period before ASP implementation (November 2012 to October 2013) and a
one-year period after its implementation (June 2015 to May 2016). For each period,
antimicrobial prescriptions for all adult outpatients (hospitalized for <24h) were evaluated by an infectious disease specialist and an emergency department
physician to assess compliance with local prescribing guidelines. Inappropriate prescriptions
were then classified.
Findings
Before and after ASP, 34,671 and 35,925 consultations were registered at our emergency
department, of which 25,470 and 26,208 were outpatients. Antimicrobials were prescribed
in 769 (3.0%) and 580 (2.2%) consultations, respectively (P < 0.0001). There were 484 (62.9%) and 271 (46.7%) (P < 0.0001) instances of non-compliance with guidelines before and after ASP implementation.
Non-compliance included unnecessary antimicrobial prescriptions, 197 (25.6%) vs 101
(17.4%) (P<0.0005); inappropriate spectrum, 108 (14.0%) vs 54 (9.3%) (P=0.008); excessive treatment duration, 87 (11.3%) vs 53 (9.1%) (P>0.05); and inappropriate choices, 11 (1.4%) vs 15 (2.6%) (P>0.05).
Conclusion
The implementation of an ASP markedly decreased the number of unnecessary antimicrobial
prescriptions, but had little impact on most other aspects of inappropriate prescribing.
Keywords
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Article info
Publication history
Published online: July 08, 2017
Accepted:
July 4,
2017
Received:
June 16,
2017
Footnotes
☆This work was previously presented at the 27th European Congress of Clinical Microbiology and Infectious Diseases, Vienna, Austria, April 22–25th, 2017.
Identification
Copyright
© 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
