Elli Megan, Molinarolo Timothy, Mullan Aidan, Walker Laura
Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.
Mayo Clinic, Department of Pharmacy, Rochester, Minnesota.
West J Emerg Med. 2024 Nov;25(6):966-974. doi: 10.5811/westjem.17998.
We aimed to assess antibiotic stewardship by quantifying the use of first-dose intravenous (IV) vs oral-only antibiotics and the frequency with which antibiotic class was changed for discharged patients. Secondary aims included the following: evaluation of the relative length of stay (LOS); differences in prescribing patterns between clinician types; differences between academic and community settings; assessment of prescribing patterns among emergency department (ED) diagnoses; and frequency of return visits for patients in each group.
This was a retrospective cohort study including patients presenting to EDs with infections who were discharged from our Midwest healthcare system consisting of 17 community hospitals and one academic center. We included infection type, antibiotic class and route of administration, type of infection, LOS, return visit within two weeks, clinician type, and demographics. Data were collected between June 1, 2018-December 31, 2021 and analyzed using descriptive statistics.
We had 77,204 ED visits for patients with infections during the study period, of whom 3,812 received IV antibiotics during their visit. There were more women (62.4%) than men included. Of the 3,812 patients who received IV antibiotics, 1,026 (34.3%) were discharged on a different class of antibiotics than they received. The most common changes were from IV cephalosporin to oral quinolone or penicillin. Patients treated with IV antibiotics prior to discharge had a longer LOS in the ED (median difference of 102 minutes longer for those who received IV antibiotics). There was not a significant difference in the use of IV antibiotics between the academic center and community sites included in the study.
Administering IV antibiotics as a first dose prior to oral prescriptions upon discharge is common, as is shifting classes from the IV dose to the oral prescription. This offers an opportunity for intervention to improve antibiotic stewardship for ED patients as well as reduce cost and length of stay.
我们旨在通过量化出院患者首剂静脉注射（IV）抗生素与仅口服抗生素的使用情况以及抗生素类别变更的频率来评估抗生素管理。次要目标包括：评估相对住院时间（LOS）；不同类型临床医生的处方模式差异；学术机构与社区机构之间的差异；急诊科（ED）诊断中的处方模式评估；以及每组患者的复诊频率。
这是一项回顾性队列研究，纳入了在我们中西部医疗系统（由17家社区医院和1家学术中心组成）因感染就诊于急诊科且已出院的患者。我们纳入了感染类型、抗生素类别和给药途径、感染类型、住院时间、两周内的复诊情况、临床医生类型以及人口统计学信息。数据收集于2018年6月1日至2021年12月31日期间，并使用描述性统计方法进行分析。
在研究期间，我们共对77204例感染患者进行了急诊科就诊，其中3812例在就诊期间接受了静脉注射抗生素治疗。纳入的女性患者（62.4%）多于男性患者。在接受静脉注射抗生素治疗的3812例患者中，有1026例（34.3%）出院时使用的抗生素类别与就诊时不同。最常见的变更情况是从静脉注射头孢菌素改为口服喹诺酮类或青霉素类。出院前接受静脉注射抗生素治疗的患者在急诊科的住院时间更长（接受静脉注射抗生素治疗的患者中位差异长102分钟）。研究中纳入的学术中心与社区机构在静脉注射抗生素的使用方面没有显著差异。
出院时在口服处方前先给予静脉注射抗生素作为首剂的情况很常见，从静脉注射剂量改为口服处方时变更抗生素类别也很常见。这为干预提供了机会，以改善急诊科患者的抗生素管理，同时降低成本和缩短住院时间。
