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BackgroundIt is considered that 30% to 50% of antibiotic prescriptions in the Emergency Department (ED) are inappropriate. Urinary tract infections (UTI) are one of the most commonly diagnosed infections in the ED.PurposeTo assess the appropriateness of antibiotic prescriptions for UTI in the ED of a tertiary hospital.Material and methodsObservational, retrospective study which included patients who attended the ED, during November 2016, with an antibiotic prescription and an UTI discharge diagnosis. To assess the appropriateness of antibiotic prescriptions, they were compared to local empirical antibiotic treatment guidelines. Data were collected from the medical records of patients.ResultsOne hundred and eighty-four antibiotic prescriptions for UTI were included, representing 27.2% (676) of all antibiotics prescribed during the period of study. One hundred and thirty-eight females (75%), mean age 45.8±20.3. Patients’ diagnoses were: 61.4% (113) acute or recurrent lower UTI in females, 17.4% (32) UTI in males, 13% (24) pyelonephritis, 5.4% (10) catheter-related infections, 2.2% (four) prostatitis and 0.5% (one) bacteriuria.Prescribed antibiotics were: 32.1% (59) fosfomycin trometamol, 20.7% (38) ciprofloxacin, 14.1% (26) amoxicillin/clavulanate, 6.5% (12) cefixime, 5.8% (10) cefuroxime, 5.4% (10) calcium fosfomycin, 4.9% (nine) norfloxacyn, 4.3% (eight), cefditoren, 2.7% (five) levofloxacin, 2.2% (four) amoxicillin, 1.1% (two) asymptomatic ceftibuten and 0.5% (one) doxycycline.In 90.8% (167) of the prescriptions, the use of an antibiotic drug was indicated. When indicated, an appropriate antibiotic was selected in 61.7% (103/167) of the prescriptions, with an appropriate dosage and duration of antibiotic treatment in 77.7% (80/103) and 68% (70/103) of the prescriptions, respectively.In 16.3% (30) and 39.7% (73) of the analysed episodes, patients required previous or subsequent medical assistance (Emergency Department, ambulatory care and hospitalisation) for UTI, respectively.ConclusionOur results show a low appropriateness of antibiotic prescriptions mainly due to an incorrect selection of the antibiotic, dosage and duration. There is also an overuse of broad spectrum antibiotics: amoxicillin/clavulanate and ciprofloxacin. More than one-third of the patients needed subsequent medical assistance.Adherence to local empirical antibiotic treatment guidelines for UTI treatment should be enhanced, as the basis of a series of strategies to optimise antibiotic prescriptions in this area.No conflict of interest

BackgroundAntibiotics represent one of the most prescribed therapeutic agents in the Emergency Department (ED). It is considered that 26% to 62% of outpatient antibiotic prescriptions are made in this area. About 30% to 50% of these prescriptions are inappropriate.PurposeTo assess the appropriateness of antibiotic prescriptions in the ED of a tertiary hospital to conform to the local empirical antibiotic treatment guidelines.Material and methodsObservational, retrospective study including patients who attended the ED, during November 2016, with an antibiotic prescription. To assess the appropriateness of antibiotic prescriptions, they were compared to local empirical antibiotic treatment guidelines. Data were collected from the medical records of patients.ResultsSix hundred and seventy-six patients were included, 386 females (57. 1%), mean age 47.4±21.2 years. Patients’ diagnoses were: 27.2% (184) urinary tract infections (UTI), 24.1% (163) lower respiratory tract infections, 15.4% (104) skin and soft tissue infections (SSTI), 13.8% (93) upper respiratory tract infections, 11.8% (80) oral infections, 2.7% (18) genital and sexually transmitted infections, 1.6% (11) gastrointestinal infections, 0.3% (two) ocular infections and 3.1% (21) other (where there were no registers of infection or could not be categorised in any of the previous locations). The most prescribed antibiotic families were: 44.1% (298) penicillins, 21.3% (144) fluoroquinolones, representing more than 60% of all antibiotic prescriptions. The most prescribed antibiotics by location were: fosfomycin trometamol in UTI (32.1%), levofloxacin in lower respiratory tract (46.2%) y amoxicillin/clavulanate in upper respiratory tract (46.6%), SSTI (62.5%) and oral infections (71.6%). In 56.8% (384) of the prescriptions, the use of an antibiotic drug was indicated. Nevertheless, the appropriate antibiotic was selected only in 62% (238) of the prescriptions. An appropriate dosage and duration of antibiotic treatment was selected in 828% (197) and 45.4% (108) of the prescriptions, respectively. In 22.9% and 35.1% of the analysed episodes, patients required previous or subsequent medical assistance.ConclusionAppropriateness of antibiotic prescriptions was low. Noncompliance was mainly due to an overuse of antibiotics when not indicated, incorrect treatment duration and overuse of broad spectrum antibiotics. The need for subsequent medical assistance could be related to treatment failure. These data reinforce the need to develop an antimicrobial stewardship programme in the ED, where emergency medicine pharmacists could be decisive in influencing inappropriate antimicrobial use and by enhancing adherence to local empirical antibiotic treatment guidelines.No conflict of interest

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Background and importance Cancer patients are a vulnerable population for SAR-CoV-2 infection. Aim and objectives The aim of our study was to describe the epidemiology and clinical course of patients with cancer infected with SARS-Cov-2, attending hospital. Material and methods A retrospective observational study was conducted in cancer patients attending a tertiary hospital for SARS-CoV-2 infection during the period 3 January 2020 to 31 May 2020. Demographic and clinical variables were analysed: comorbidities, tumour diagnosis, tumour stage and whether they had received anticancer treatment in the last month (active treatment). The clinical course was evaluated by hospital admission, pneumonia, oxygen therapy requirements, the development of acute respiratory distress syndrome (ARDS), admission to ICU, mortality rate and mortality rate <30 days from admission. Quantitative variables were expressed as means (SD). The association between dichotomous variables or proportions was compared using Fisher's exact test and between quantitative variables using the Mann-Whitney U test. Results 112 patients were included, 59.8% (67) were men, mean age 67±13.4 years. 94.6% (106) were Caucasian (4.4% (5) Latino). 61.6% (69) were non-smokers, 25% (28) exsmokers and 13.4% (15) current smokers; 11.6% (13) had obesity. The most frequent comorbidities were: 57.1% (64) arterial hypertension, 34.8% (38) cardiovascular disease, 32.1% (36) diabetes mellitus and 21.4% (24) COPD. The most frequent cancer diagnosis were: 18.8% (21) breast cancer, 17.9% (20) lung cancer, 16.1% (18) colorectal cancer and 12.5% (14) prostate cancer. Tumour stage: 55.4% (62) metastatic disease, 25% (28) localised disease and 19.6% (22) locally advanced disease. 60.7% (68) of patients received active cancer treatment (42.7% chemotherapy, 32.3% hormonal treatment, 16.2% targeted therapy, 7% immunotherapy and 2.9% radiotherapy). At admission, 85.7% (96) of patients