Pre-treatment pathogen testing rates before antimicrobial therapy in emergency departments: a four-year retrospective...

To monitor and analyze the current status and trends in pretreatment pathogen testing rates for antimicrobial therapy in the emergency departments of two campuses of a tertiary hospital, explore key factors influencing pathogen testing rate, and propose improvement strategies.

Data from 534,374 visits from the emergency departments between 2021 and 2024 were collected via the hospital information system, outpatient logs, and laboratory management system. Antibiotic utilization rates and pretreatment pathogen testing rates were calculated. Statistical analyses included chi-square tests, Cochran-Armitage trend tests, Cramer's V, and logistic regression.

Over four years, antimicrobial usage increased from 17.95% to 22.59% (Z = 41.79, P < 0.001), whereas the pathogen testing rate remained consistently low at 13.08%-14.17%, with no improvement (Z=-1.70, P = 0.089). The pathogen testing rate at Dongjie Campus was significantly lower than that at East City Campus in all years (P < 0.001). From 2021 to 2023, the pathogen testing rate in internal medicine departments exceeded that in surgical departments, but this trend reversed for the first time in 2024 (internal medicine: 12.42% vs. surgery: 13.86%, P<0.001). Procalcitonin was the primary specimen type, with its proportion declining annually; Mycoplasma pneumoniae testing showed rapid growth; and traditional bacterial culture consistently accounted for less than 5% of the samples.

Emergency antimicrobial usage rates have persistently increased, whereas pathogen testing rates have remained chronically low, revealing a prominent contradiction of "high usage, low submission." Significant variations exist across campuses and departments. The submission structure is imbalanced, with severe inadequacies in microbial culture. We recommend establishing a multidisciplinary collaborative management model, strengthening information-based interventions, optimizing submission workflows, and implementing long-term oversight and incentive mechanisms to achieve targeted antimicrobial therapy and antimicrobial resistance control objectives.