Empiric outpatient antibiotic prescribing patterns in the emergency department

Inappropriate antimicrobial use in outpatient settings, such as Emergency Departments (EDs), is associated with increased risk of morbidity, costs, and antibiotic resistance. Prescribing patterns and guideline concordance in the ED is not well described in the literature. The primary objective of this study was to describe the empiric outpatient antibiotic prescribing patterns for frequent community-acquired infections seen in the ED at a large tertiary care teaching hospital. The secondary objectives were to evaluate concordance of antimicrobial prescribing with local guidelines, quantify the proportion of patients requiring antibiotic modification based on culture results, and 30-day ED revisits for the same infection.

A retrospective chart review was conducted on a convenience sample of 200 adult patients discharged from the ED between October 1, 2022 to July 18, 2023. Data was analyzed to determine prescribing patterns and guideline concordance.

The most common infectious syndrome observed was skin and soft tissue infections (SSTIs). Overall, discordance was observed in 80% of cases, with 100% discordance seen with the treatment of COPD exacerbation and mild purulent SSTIs. Guideline discordance was predominantly due to treatment duration (67%) and antimicrobial selection (43%). Culture-directed therapy modifications were minimal (5%). There was no significant difference between antimicrobial concordance and therapy modification or between overall guideline concordance and 30-day revisit rates.

Outpatient antimicrobial prescribing in the ED remains suboptimal despite available treatment guidelines, particularly in skin and respiratory infections. Discordance, mainly driven by extended treatment durations, highlights the need for improved Antimicrobial Stewardship practices in ED settings.