Appropriate Antibiotic Prescribing in the Emergency Department A Cross-sectional Study

Background Data on appropriate antibiotic prescribing in the emergency department (ED) are scarce. The aims of this study were to determine the proportion of ED presentations resulting in antibiotic prescribing and to assess the rate of appropriate antibiotic prescribing in patients receiving antibiotics in the ED over a 4-year period. Methods A random sample (10%) of all consecutive patients who visited the ED and received antibiotics between 2013 and 2016 was selected, and 2 independent researchers assessed appropriateness of prescribed antibiotics based on the documented indication. Appropriateness was defined as being in accordance with local antibiotic guidelines at the time. A deviation of antibiotic guidelines with a clearly documented reason was assessed as appropriate. If the indication was surgical prophylaxis, antibiotic appropriateness was not assessed. Results Antibiotics were prescribed in 14,461 ED presentations (14.8%), of which 1435 (9.9%) were reviewed. Antibiotic appropriateness was assessed for 1262 indications (excluding surgical prophylaxis). In total, 915 cases (72.5%) were assessed as appropriate, 298 (23.6%) as inappropriate, and 49 (3.9%) were deemed not assessable. The interrater reliability was good (k = 0.78). Appropriate antibiotic prescribing did not significantly differ between years (P = 0.67). Sepsis was most appropriately treated (93%). Skin and soft tissue infections and upper respiratory infections were treated least appropriately (58.4% and 59.5%). Cultures were obtained in 764 patients (75.4%) receiving antibiotics. Conclusions Antibiotics were prescribed in 15% of ED presentations, and 24% of antibiotic prescriptions were assessed as inappropriate, indicating an urgent need to improve awareness and adherence to antibiotic guidelines in the ED.