Adherence to guidelines on empiric use of antibiotics in the emergency room

In October 2002, guidelines for empiric antibiotics in emergency room (ER) were introduced.

To evaluate physician's compliance with guidelines and their utility in improving patient care.

Reviewing charts of patients admitted to ER during October 4, 2004 to February 14, 2005 with suspected infection, subsequently hospitalized to internal medicine ward. Along with demographic data, the following parameters were recorded: Initiating antibiotics in ER, according-to-guidelines treatment (ATGT), lag-time between admittance and first antibiotic dose, diagnosis, proper coverage of pathogens by treatment (PCPT), and outcome.

A total of 534 patients were admitted to ER with a suspected infection, 481 (90.1%) of them were managed according to guidelines, and from the 431 patients (80.7%) who received antibiotics, 381 (88.4%) were given ATGT. In 105 cases (19.7%), positive cultures (urine or blood) were obtained: 23.6% and 30.0% of the patients who received ATGT and not-ATGT, and the given antibiotic ensured proper coverage of the pathogen which grew in 73.3% and 46.7% of the cases, respectively. Percentages of good outcome (staying alive) for ATGT, non-ATGT, PCPT, and not-PCPT were 92.1%, 76.0%, 89.0%, and 69.0%, respectively. By multivariate analysis, early ATGT proved to be related to good outcome.

Physicians' compliance with hospital guidelines to empiric antibiotics in ER was high. Adherence to guidelines was associated with a better outcome. Local susceptibility patterns to antibiotics need to be actively monitored. Prompt administration of antibiotics in the ER is likely to have a favorable outcome on survival, yet larger studies are required to establish this conclusively.