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Analysis of quality antimicrobial agent use in the emergency department of a tertiary care hospital

Oltra Hostalet F, Núñez-Núñez M, Portillo Cano MM, Navarro Bustos C, Rodríguez-Baño J, Retamar Gentil P

Unidad de Gestión Clínica de Urgencias, Hospital Universitario Virgen Macarena, Sevilla, Spain. Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen Macarena, Sevilla, España. Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva/Instituto de Biomedicina de Sevilla (IBIS)/Hospital Universitario Virgen Macarena/Consejo Superior de Investigaciones Científicas (CSIC), Sevilla, Spain. Departamento de Medicina. Universidad de Sevilla, Spain.

Objective. To describe modifiable factors related to inappropriate antimicrobial treatment in the observation area of an emergency department to explore practices that can be targeted for change through a program to improve emergency use of antimicrobial agents, the PROA program in its spanish observations.
Methods. Cross-sectional serial point-prevalence study of all antimicrobial prescriptions for patients under observation in the department in February and March 2015.The main outcome measure was the frequency of antimicrobial treatment that was inappropriate according the center’s guidelines. Two evaluators assessed appropriateness.
Results. We analyzed 406 antimicrobial treatments. The main clinical syndromes were pneumonia (24%), urinary infections (22%), and nonpneumonia lower respiratory infections (22%). We found that 51.5% of the antimicrobial treatments were inappropriate. Factors associated with inappropriate prescriptions were a failure to analyze microbiologic
samples before treating (61%), failure to specify the focus of infection in the case records (73%), and failure to meet the definition of sepsis (58%).
Conclusions. Fewer than half the antimicrobial treatments were appropriate as prescribed. Signs of serious infection, specification of the focus of infection in the patient’s records, and the analysis of biologic samples were independent predictors of quality care (appropriate antimicrobial prescription). These factors can be targeted for training in the development
of a specific emergency department program to improve this aspect of care.

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