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. 2017 Nov;97(3):288-293.
doi: 10.1016/j.jhin.2017.07.005. Epub 2017 Jul 8.

Impact of an antimicrobial stewardship programme to optimize antimicrobial use for outpatients at an emergency department

A Dinh  1 , C Duran  2 , B Davido  2 , F Bouchand  3 , L Deconinck  2 , M Matt  2 , O Sénard  2 , C Guyot  4 , A-So Levasseur  4 , J Attal  4 , D Razazi  4 , T Tritz  5 , A Beauchet  6 , J Salomon  2 , S Beaune  4 , J Grenet  4
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Impact of an antimicrobial stewardship programme to optimize antimicrobial use for outpatients at an emergency department

A Dinh et al. J Hosp Infect. 2017 Nov.

Abstract

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: Antimicrobial stewardship; Antimicrobial treatment; Community-acquired infection; Emergency department; Infectious disease specialist.

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