Rafferty Aisling, Talento Alida Fe, Drew Richard, Fitzpatrick Patrick, Tedford Kara, Barrett Michael, Mahomed Husnain, O'Regan Sabrina, Delany Louise, O'Connor Síle, Buseckyte Agne, Brovchin Andrei, Hassan Elhaytham, Marzec Anna, Martin Donna, Greene Clare, Marriott John, Cunney Robert
Department of Pharmacy, Children's Health Ireland at Temple Street, Dublin, Ireland.
School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.
JAC Antimicrob Resist. 2024 Mar 12;6(2):dlae038. doi: 10.1093/jacamr/dlae038. eCollection 2024 Apr.
To determine the percentage of patients across Ireland who are discharged from the Emergency Department (ED) with an antimicrobial prescription, the indication, classification of infections, and guideline compliance. To identify potential areas for antimicrobial stewardship (AMS) interventions in the ED.
A multicentre, prospective cohort analysis study in EDs across eight hospitals in Ireland. At each site, patients aged 1 month and older who presented to the ED and were discharged directly from the ED were included. A random selection of records of patients discharged from the ED were reviewed until a minimum of 30 records with an infection diagnosis resulting in an antibiotic prescription were obtained per hospital. The number of patient discharges with no antibiotic prescriptions were included to calculate the denominator. The indication, infection classification and guideline compliance data were collected on the 30 prescriptions in the participating hospitals.
A total of 2619 patient records were reviewed. Of these, 249 (9.5%) patients were discharged with antimicrobial prescriptions from the ED. Most (158; 63%) were classified as probable bacterial infection, 21 (8%) as probable viral, and 18 (7%) had no documented evidence of infection. Three indications accounted for 73% of antimicrobial prescriptions: skin/soft tissue infection; ear, nose and throat infection; and urinary tract infection. Overall guideline compliance was 64%.
Several areas for AMS interventions to optimize antimicrobial prescribing in the ED were identified, including targeted local and national guideline reviews, delayed prescribing, improved point-of-care testing and prescriber and patient education.
确定爱尔兰急诊科出院时开具抗菌药物处方的患者百分比、用药指征、感染分类以及指南依从性。确定急诊科抗菌药物管理（AMS）干预的潜在领域。
在爱尔兰八家医院的急诊科开展一项多中心前瞻性队列分析研究。在每个研究点，纳入年龄1个月及以上、到急诊科就诊并直接从急诊科出院的患者。随机抽取急诊科出院患者的记录进行审查，直至每家医院至少获得30份因感染诊断而开具抗生素处方的记录。纳入未开具抗生素处方的出院患者数量以计算分母。收集参与研究医院30份处方的用药指征、感染分类和指南依从性数据。
共审查了2619份患者记录。其中，249例（9.5%）患者从急诊科出院时开具了抗菌药物处方。大多数（158例；63%）被归类为可能的细菌感染，21例（8%）为可能的病毒感染，18例（7%）无感染的记录证据。三个用药指征占抗菌药物处方的73%：皮肤/软组织感染、耳鼻喉感染和尿路感染。总体指南依从性为64%。
确定了几个AMS干预领域，以优化急诊科抗菌药物处方，包括有针对性的地方和国家指南审查、延迟处方、改进即时检验以及对开处方者和患者进行教育。
