Department of Emergency Medicine, University of California Davis, Sacramento, CA, USA.
Department of Emergency Medicine, IdiPAZ, La Paz University Hospital, Madrid, Spain.
Clin Microbiol Infect. 2021 Feb;27(2):204-209. doi: 10.1016/j.cmi.2020.10.028. Epub 2020 Nov 2.
Emergency departments (EDs) are the entrance gates for patients presenting with infectious diseases into the hospital, yet most antimicrobial stewardship programmes are primarily focused on inpatient management. With equally high rates of inappropriate antibiotic use, the ED is a frequently overlooked yet important unit for targeted antimicrobial stewardship (AMS) interventions.
We aimed to (a) describe the specific aspects of antimicrobial stewardship in the ED and (b) summarize the findings from improvement studies that have investigated the effectiveness of antimicrobial stewardship interventions in the ED setting.
(a) a PubMed search for 'antimicrobial stewardship' and 'emergency department', and (b) published reviews on effectiveness combined with publications from the first source.
(a) An in depth analysis of selected publications provided four key antimicrobial use processes typically performed by front-line healthcare professionals in the ED: making a (tentative) clinical diagnosis, starting empirical therapy based on that diagnosis, performing microbiological tests before starting that therapy and following up patients who are discharged from the ED. (b) Further, we discuss the literature on improvement strategies in the ED focusing on guidelines and clinical pathways and multifaceted improvement strategies. We also summarize the evidence of microbiologic culture review.
Based on our review of the literature, we describe four essential elements of antimicrobial use in the ED. Studying the various interventions targeting these care processes, we have found them to be of a variable degree of success. Nonetheless, while there is a paucity of AS studies specifically targeting the ED, there is a growing body of evidence that AS programmes in the ED are effective with modifications to the ED setting. We present key questions for future research.
急诊科是传染病患者进入医院的入口，但大多数抗菌药物管理计划主要侧重于住院患者管理。由于同样存在不合理使用抗生素的高比率，急诊科是一个经常被忽视但却非常重要的目标抗菌药物管理（AMS）干预单位。
我们旨在（a）描述急诊科抗菌药物管理的具体方面，以及（b）总结研究抗菌药物管理干预措施在急诊科环境中有效性的改进研究结果。
（a）PubMed 中搜索“抗菌药物管理”和“急诊科”，以及（b）与第一个来源的出版物结合的已发表的关于有效性的综述。
（a）对选定出版物的深入分析提供了一线医护人员在急诊科通常进行的四个关键抗菌药物使用流程：做出（暂定）临床诊断，根据该诊断开始经验性治疗，在开始治疗前进行微生物学检测，以及对从急诊科出院的患者进行随访。（b）此外，我们讨论了急诊科的改进策略文献，重点是指南和临床路径以及多方面的改进策略。我们还总结了微生物培养回顾的证据。
根据我们对文献的回顾，我们描述了急诊科抗菌药物使用的四个基本要素。研究针对这些护理流程的各种干预措施，我们发现它们的成功率各不相同。尽管针对急诊科的抗菌药物管理研究相对较少，但越来越多的证据表明，对急诊科环境进行修改后，抗菌药物管理计划在急诊科是有效的。我们提出了未来研究的关键问题。
