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Antibiotic Guideline Adherence at the Emergency Department: A Descriptive Study from a Country with a Restrictive
Mariana B Cartuliares1,2, Sara N Søgaard1,2, Flemming S Rosenvinge3,4
1Department of Emergency Medicine, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark.
Background:
Denmark has a low level of antimicrobial resistance (AMR). Patients hospitalized with suspected infection often present with unspecific symptoms. This challenges the physician between using narrow-spectrum antibiotics in accordance with guidelines or broad-spectrum antibiotics to compensate for diagnostic uncertainty. The aim of this study was to investigate adherence to a restrictive antibiotic guideline for the most common infection in emergency departments (EDs), namely community-acquired pneumonia (CAP).
Method:
This multicenter descriptive cross-sectional study included adults admitted to Danish EDs with a suspected infection. Data were collected prospectively from medical records.
Results:
We included 954 patients in the analysis. The most prescribed antibiotics were penicillin with beta-lactamase inhibitor at 4 h (307 (32.2%)), 48 h (289 (30.3%)), and day 5 after admission (218 (22.9%)). The empirical antibiotic treatment guidelines for CAP were followed for 126 (31.3%) of the CAP patients. At 4 h, antibiotics were administered intravenously to 244 (60.7%) of the CAP patients. At day 5, 218 (54.4%) received oral antibiotics.
Conclusion:
Adherence to CAP guidelines was poor. In a country with a restrictive antibiotic policy, infections are commonly treated with broad-spectrum antibiotics against recommendations.
Insights
Physicians frequently used broad-spectrum antibiotics for community-acquired pneumonia (CAP), despite Denmark
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Public Health
Background:
- Denmark has low antimicrobial resistance (AMR).
- Unspecific symptoms in suspected infections create diagnostic uncertainty.
- Physicians face a dilemma between guideline-adherent narrow-spectrum and broad-spectrum antibiotics.
Purpose of the Study:
- To assess adherence to restrictive antibiotic guidelines for community-acquired pneumonia (CAP).
- To evaluate antibiotic prescribing practices in Danish emergency departments (EDs).
Main Methods:
- Multicenter descriptive cross-sectional study.
- Prospective data collection from medical records of adult patients in Danish EDs.
- Analysis of 954 patients admitted with suspected infections.
Main Results:
- Adherence to CAP empirical antibiotic treatment guidelines was low (31.3%).
- Penicillin with beta-lactamase inhibitor was the most prescribed antibiotic.
- Intravenous antibiotics were common initially (60.7% at 4h), with a shift to oral by day 5 (54.4%).
Conclusions:
- Adherence to CAP guidelines was poor.
- Broad-spectrum antibiotics were frequently used, contrary to recommendations in a restrictive antibiotic policy setting.
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