Bacteraemia in the ED: Are We Meeting Targets?

Area of Science:

• Infectious Diseases
• Clinical Audit
• Emergency Medicine

Background:

• Antimicrobial stewardship is critical in combating antibiotic resistance and improving patient outcomes.
• Sepsis remains a leading cause of mortality, necessitating prompt and appropriate antimicrobial treatment.
• Emergency Departments (EDs) are key settings for initial sepsis diagnosis and management.

Purpose of the Study:

• To audit adherence to established antimicrobial guidelines in an Irish Emergency Department.
• To identify common clinical presentations of sepsis within the ED setting.
• To assess the impact of guideline adherence on antibiotic coverage for bloodstream infections.

Main Methods:

• A three-month audit of patients with clinically significant bacteraemia in an ED.
• Comparison of prescribed antimicrobials against hospital guidelines for the ED diagnosis.
• Data collection on patient demographics, causative organisms, and antibiotic prescribing patterns.

Main Results:

• A significant proportion of patients (81%) were treated with non-adherence to antimicrobial guidelines.
• Only 19% of patients received antibiotics in line with hospital guidelines.
• Escherichia coli was the most frequently isolated organism (35.70%).

Conclusions:

• Non-adherence to antimicrobial guidelines was prevalent, leading to suboptimal antibiotic coverage (68%).
• Adherence to guidelines resulted in significantly better antibiotic coverage (87%).
• There is a clear need to improve physician adherence to antimicrobial guidelines in the ED to optimize sepsis treatment.