Antimicrobial Stewardship in the Emergency Department

Abstract

The literature contains robust evidence on the positive impact of antimicrobial stewardship programs (ASP) in the inpatient setting. With national policies shifting toward provisions of quality health care, the impetus to expand ASP services becomes an important strategy for institutions. However data on stewardship initiatives in other settings are less characterized. For organizations with an established ASP team, it is rational to consider expanding these services to the emergency department (ED). The ED serves as an interface between the inpatient and community settings. It is often the first place where patients present for medical care, including for common infections. Challenges inherent to the fast-paced nature of the environment must be recognized for successful ASP implementation in the ED. Based on the current literature, a combination of strategies for initiating ASP services in the ED will be described. Furthermore, common scenarios and management approaches are proposed for respiratory tract, skin and soft tissue, and urinary tract infections. Expansion of ASP services across the health care continuum may improve patient outcomes with a potential associated decrease in health care costs while preventing adverse effects including the development of antibiotic resistance.

Adequacy of the special category antibiotics prescriptions in the Emergency Department of a third level urban Hospital

“…Según la Organización Mundial de la Salud (OMS), la no adherencia a las guías de práctica clínica y la prescripción indiscriminada de antibióticos de espectro mayor al necesitado son dos de las primeras causas de aparición de resistencias antimicrobianas, ya consideradas como un problema de salud pública a nivel mundial [2,3]. Además, el uso inadecuado de antimicrobianos se relaciona con una mayor incidencia de fracaso terapéutico, un aumento de la morbimortalidad y una utilización ineficiente de los recursos [4][5][6]. La Sociedad Americana de Enfermedades Infecciosas (IDSA) recomienda la implementación de guías de tratamiento empírico adaptadas a la ecología local de cada centro para evitar la aparición de resistencias y como herramienta para disminuir la morbimortalidad, la estancia hospitalaria y los costes sanitarios [7].…”

Antimicrobial stewardship in diabetic ketoacidosis: a single‐centre experience

“…13 It is interesting to note that this analysis reports a substantially lower incidence of infection compared to previous studies including from this facility, despite the tropical climate. There was a low correlation with regard to suspected infection on presentation and probable or proven infection on admission.…”

“…These findings are consistent with international emergency department (ED) studies demonstrating inappropriate prescription and broad spectrum use of antimicrobial therapy for RTI, UTI, and skin and soft tissue infection. 13 It is interesting to note that this analysis reports a substantially lower incidence of infection compared to previous studies including from this facility, despite the tropical climate. [3][4][5][6] However, the infection incidence of 14.5% was similar to that reported by Randall et al 14 , who reviewed low socioeconomic status minority patients.…”

“…This approach is more likely to overcome appropriate prescription barriers, which include social, environmental and education factors. 13,18,19 A limitation to this study is its retrospective nature of review of medical records and as such some data may be incorrect or unavailable. Specifically, incomplete data relating to antimicrobial dosage and patient weight limited the ability to further classify appropriate prescribing further as per the National Antimicrobial Prescribing Survey assessment tool.…”

Antimicrobial Drug Consumption in Emergency Services at North West (Tabuk) Region Hospitals, Saudi Arabia

“…The emergency hospital services at the northern region at Kingdom of Saudi Arabia is demanding to antibiotics stewardship and prescribing guidelines for adults, pediatrics and neonatal cases. [12][13][14] inappropriate antibiotic use is a major constituent of unreasonable drug recommending in children.…”