Assessments of Opportunities to Improve Antibiotic Prescribing in an Emergency Department: A Period Prevalence Survey

Timbrook, Tristan T; Caffrey, Aisling R.; Ovalle, Anais; Beganovic, Maya; Curioso, William; Gaitanis, Melissa; LaPlante, Kerry L.

doi:10.1007/s40121-017-0175-9

Cited by 37 publications

(30 citation statements)

References 40 publications

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“…The patterns of antimicrobial prescribing in veterinary emergency and critical care (ECC) settings have not been previously described. A study of human emergency room (ER) practice found that 39% of antimicrobial drug prescriptions were inappropriate (21). This observation raises questions regarding the appropriateness of prescribing in veterinary ECC settings.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care

et al. 2020

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Background: Antimicrobial use contributes to emergence of antimicrobial resistance. It was hypothesized that antimicrobial prescribing behavior varies between the emergency (ER) and critical care (CC) services in a veterinary teaching hospital. This study aimed to: (i) describe antimicrobial prescribing patterns in the ER and CC services; (ii) assess adherence to stewardship principles; (iii) evaluate the prevalence of multidrug resistant (MDR) bacterial isolates. Methods: Institution electronic medical records were queried for all antimicrobial prescriptions from the ER and CC services between 1/1/2017 and 12/31/2017. Prescriptions were manually reviewed, and the following data recorded: drug, dosage, duration, diagnosis, outcome, hospitalization duration, culture submission, and susceptibility results. Results: There were 5,091 ER visits, of which 3,125 were not transferred to another service. Of these emergency visits, 516 (16.5%) resulted in 613 antimicrobial drug prescriptions. The most commonly prescribed drugs for the ER were amoxicillin/clavulanate (n = 243, 39.6%), metronidazole (n = 146, 23.8%), and ampicillin/sulbactam (n = 55, 9.0%). The most common reasons for antimicrobial prescriptions were skin disease (n = 227, 37.0%), gastrointestinal disease (n = 173, 28.2%), and respiratory disease (n = 50, 8.2%). For ER patients 18 cultures were submitted, equivalent to a 3.5% submission rate. The CC service managed 311 case visits for 822 patient days. Of these, 133 case visits (42.7%) resulted in 340 prescriptions. The most commonly prescribed drugs for the CC service were ampicillin/sulbactam (n = 103, 30.3%), enrofloxacin (n = 75, 22.1%), and metronidazole (n = 59, 17.4%). The most common reasons for antimicrobial prescriptions were gastrointestinal disease (n = 106, 31.2%), respiratory disease (n = 71, 20.9%), and sepsis (n = 61, 17.9%). On the CC service, 46 patients had ≥1 culture submitted, equivalent to a 34.6% submission rate. Of patients prescribed antimicrobials, 13/38 (34%) with urinary tract disease, 2/28 (7%) with pneumonia, 1/11 (9%) with canine infectious respiratory disease complex and 2/8 (25%) with feline upper respiratory infection were compliant with published guidelines. Robbins et al. Antimicrobial Prescribing Emergency Critical Care Conclusions: Antimicrobial prescription was common in both ER and CC services and followed similar patterns. Adherence to published guidelines for urinary and respiratory infections was poor.

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Section: Introductionmentioning

confidence: 99%

Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care

et al. 2020

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“…Beta‐lactams are the most commonly used first‐line antibiotics globally, with cephalosporin use approaching penicillin use in recent decades . It was previously reported that a cross‐reactive cephalosporin allergy occurs in 10% of penicillin‐allergic patients .…”

Section: Introductionmentioning

confidence: 99%

“…Beta-lactams are the most commonly used first-line antibiotics globally, with cephalosporin use approaching penicillin use in recent decades. [1][2][3] It was previously reported that a cross-reactive cephalosporin allergy occurs in 10% of penicillin-allergic patients. 4 This figure relates to studies prior to the 1980s, which demonstrated cross-reactivity between benzylpenicillin and first and second generation cephalosporins.…”

Section: Introductionmentioning

confidence: 99%

Immediate cephalosporin allergy

Yuson

Kumar

et al. 2019

Internal Medicine Journal

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Background Patients who suffer from acute IgE‐mediated allergy to a cephalosporin antibiotic are frequently assumed to be at high risk of allergy to other cephalosporins and penicillins. Aim To define cross‐reactivity patterns in patients with confirmed allergy to a cephalosporin. Methods Subjects presenting with a history of immediate allergy to a cephalosporin‐family antibiotic between March 2009 and July 2017 were investigated with specific IgE testing to penicillin, amoxycillin and cefaclor, followed by skin prick testing, intradermal testing and drug provocation testing with a panel of penicillins and cephalosporins. Results Out of 564 subjects with a reported beta‐lactam allergy, 90 identified a cephalosporin as their index drug. Fifty‐five (61.1%) of the 90 subjects tested had a history consistent with an IgE‐mediated reaction, of whom 24 (43.6%) were proven to be allergic to their index cephalosporin. Twenty (83.3%) of the 24 were allergic only to their index cephalosporin. Of the four remaining subjects, two were co‐sensitised to another beta‐lactam with a similar side chain, while the other two had no specific cross‐reactivity pattern. Major and minor penicillin determinants were negative for all cephalosporin‐allergic individuals. Conclusion In our cohort, cephalosporin allergy does not appear to be a class effect, with most cases found allergic only to their index cephalosporin. Co‐sensitisation to other cephalosporins or penicillins was uncommon, and when it occurred, was usually consistent with side chain cross‐reactivity.

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“…Further studies are still needed to evaluate the benefit of stewardship initiatives for acute bacterial skin and skin structure infections (ABSSSI), bloodstream infections, central nervous system infections, and intra-abdominal infections. Timbrook et al concluded that inappropriate antibiotic prescribing was observed in 39% of ED cases in their study [35]. The disease states that had the highest rates observed included bronchitis, upper respiratory tract infections, and skin and soft-tissue infections, and therefore special attention should be given to improving prescribing patterns for these disease states.…”

Section: Discussionmentioning

confidence: 90%

BundlED Up: A Narrative Review of Antimicrobial Stewardship Initiatives and Bundles in the Emergency Department

et al. 2019

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Antimicrobial stewardship (ASP) is becoming an increasingly high priority worldwide, yet the emergency department (ED) is an area where stewardship is often neglected. Implementing care bundles, guidelines, and protocols appears to be a rational strategy for ED stewardship given the inherently dynamic and hectic environment of care. Multiple questions still exist such as whether to target certain disease states, optimal implementation of ASP interventions in the ED, and the benefit of unique ED-specific guidelines and protocols. A narrative review was performed on interventions, guidelines, and bundles implemented in the ED setting, in an effort to improve ASP or management of infectious diseases. This review is meant to serve as a framework for the reader to implement these practices at their own institution. We examined various studies related to ASP interventions or care bundles in the ED which included: CNS infections (one study), skin and soft-tissue infections (one study), respiratory infections (four studies), urinary tract infections and sexually transmitted infections (eight studies), sepsis (two studies), culture follow-up programs (four studies), and stewardship in general or multiple infection types (five studies). The interventions in this review were diverse, yet the majority showed a benefit in clinical outcomes or a decrease in antimicrobial use. Care bundles, guidelines, and antimicrobial stewardship interventions can streamline care and improve the management of common infectious diseases seen in the ED.

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Assessments of Opportunities to Improve Antibiotic Prescribing in an Emergency Department: A Period Prevalence Survey

Cited by 37 publications

References 40 publications

Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care

Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care

Immediate cephalosporin allergy

BundlED Up: A Narrative Review of Antimicrobial Stewardship Initiatives and Bundles in the Emergency Department

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