TY - JOUR
T1 - Where to start? The Irish Emergency Department Antimicrobial Discharge (EDAD) study
T2 - a multicentre, prospective cohort analysis
AU - Rafferty, Aisling
AU - Talento, Alida Fe
AU - Drew, Richard
AU - Fitzpatrick, Patrick
AU - Tedford, Kara
AU - Barrett, Michael
AU - Mahomed, Husnain
AU - O’Regan, Sabrina
AU - Delany, Louise
AU - O’Connor, Síle
AU - Buseckyte, Agne
AU - Brovchin, Andrei
AU - Hassan, Elhaytham
AU - Marzec, Anna
AU - Martin, Donna
AU - Greene, Clare
AU - Marriott, John
AU - Cunney, Robert
N1 - Funding
A.R. was awarded funds from the Children's Health Ireland Foundation through the CHI Research & Innovation Office for DPharm fees [Seed Funding Grant Application RIO Reference RSFG-21-TRA04].
PY - 2024/3/12
Y1 - 2024/3/12
N2 - Objectives: 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. Patients and methods: 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. Results: 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%. Conclusions: 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.
AB - Objectives: 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. Patients and methods: 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. Results: 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%. Conclusions: 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.
U2 - 10.1093/jacamr/dlae038
DO - 10.1093/jacamr/dlae038
M3 - Article
C2 - 38476772
SN - 2632-1823
VL - 6
JO - JAC-Antimicrobial Resistance
JF - JAC-Antimicrobial Resistance
IS - 2
M1 - dlae038
ER -