LO072: Fever in the returning traveller: a systematic review and critical appraisal of existing clinical practice guidelines and approaches to returning travellers presenting with fever

Abstract

and 2015. All adult patients who were discharged home from the ED with a diagnosis of pneumonia were included. Severity of pneumonia was graded based on the CRB-65 score as per the CAP guidelines. Primary outcome was type of antibiotic prescribed by the ED physician. Data was analyzed using simple descriptive statistics. Results: There were a total of 141 patients analyzed during the study period (N = 46 in 2013, N = 59 in 2014, N = 36 in 2015). Demographics and relevant comorbidities were similar across the years: age (2013: median = 53 years, range 20-92 years; 2014: 56, 21-83; 2015: 54, 20-81); preexisting lung disease (30%, 27%, 25% respectively); HIV positive status (9%, 7%, 17%). CRB-65 score was: low risk (0 points) = 70% in 2013, 66% in 2014, 75% in 2015; intermediate risk (1-2 points) = 30%, 34%, 25%; high risk (3-4 points) = 0% in all years. Percentage of patients discharged home with a documented prescription was 83%, 85%, and 94% respectively. In 2013, patients received azithromycin (AZM) (n = 17, 43% of antibiotic prescriptions that year); levofloxacin (LVX) (n = 10, 25%); AMC (n = 5, 13%); clarithromycin (CLR) (n = 5, 13%); trimethoprim-sulfamethoxazole (SXT) (n = 2, 5%); doxycycline (DOX) (n = 1, 3%). In 2014: AMC (n = 26, 51%); AZM (n = 12, 24%); LVX (n = 9, 18%); CLR (n = 2, 4%); DOX (n = 1, 2%); erythromycin (ERY) (n = 1, 2%). In 2015: AMC (n = 17, 47%); AZM (n = 12, 33%); LVX (n = 4, 11%); CLR (n = 1, 3%); SXT (n = 1, 3%); DOX (n = 1, 3%). Number of return ED visits within 2 weeks were: n = 16 (35%); n = 11 (19%); and n = 10 (28%) respectively. Conclusion: The results of this study show that there has been a change in antibiotic prescribing practices in the SMH ED since dissemination of the CAP guidelines, with AMC accounting for nearly half of antibiotic prescriptions. Further antimicrobial stewardship efforts will focus on evaluating factors influencing prescribing practices.