Adherence to therapeutic recommendations regarding the use of antibiotics in an Emergency Department after a low-intensity intervention

Abstract

Introduction: The discovery of antimicrobials significantly reduced mortality from severe infections. However, antibiotic resistance has become a major issue, necessitating new strategies for antibiotic use. The aim of this study is to assess the impact of the Antimicrobial Stewardship Program (ASP) in a tertiary hospital's Emergency Department (ED), focusing on adherence to antibiotic guidelines before and after its implementation.

Methods: A retrospective descriptive study was conducted from May 2022 to February 2023, including patients admitted to the ED with respiratory infections (RI), skin and soft tissue infections (SSTI), or intra-abdominal infections (IAI). Antibiotic adherence was compared between pre-ASP (May-September 2022) and post-ASP (October 2022-February 2023) periods. The intervention involved training sessions and providing accessible documentation for ED staff.

Results: A total of 494 patients were included, with 50% in each period. Adherence to ASP guidelines improved significantly from 45.45% to 56.80% post-intervention (p<0.01). RI adherence increased notably, while SSTI and IAI adherence did not change significantly. Mortality was also evaluated. At 72 hours, mortality was 1.22% (4/328) in the adherent group and 4.82% (8/166) in the non-adherent group (p<0.05). At 30 days, mortality was 4.57% (15/328) and 12.05% (20/166), respectively (p<0.005). Carbapenem use decreased from 21.12% to 13.08% post-intervention, though this reduction was not significant

Conclusions: Low-intensity interventions can improve antibiotic adherence in EDs, potentially enhancing clinical outcomes and reducing resistance. Future studies should investigate reasons for non-adherence and examine the effects on patient outcomes and costs.