Methods: We performed a one-year cohort study of patients discharged from the ED in a tertiary care center with a prescription for oral antimicrobial agents. A retrospective audit of the appropriateness of antimicrobial prescription using prespecified criteria was performed by two infectious disease physicians. Patterns in antimicrobial prescription and the physician-, patient-, and environment-related factors predicting unnecessary/inappropriate antimicrobial prescription were evaluated.
Results: Of the 36,308 annual visits to the ED, 1,555 patients (4.3% of visit) received oral antimicrobial prescriptions upon discharge. Pneumonia (18.2% [283/1,555]) was the most common indication for antimicrobial prescription. Of the 1,555 antimicrobial prescriptions issued, 852 (52.9%) were considered inappropriate. Factors significantly associated with unnecessary/inappropriate antimicrobial prescription included the lack of comorbidities (adjusted odds ratio [aOR]: 1.39; 95 % confidence interval [CI]: 1.03-1.87), late-night visit (aOR: 1.48 95%; CI: 1.05-2.09), the spring-summer season (aOR: 1.13 95%; CI: 1.03-1.25), higher postgraduate year (>10 years) (aOR: 1.77 95%; CI: 1.24-2.52), and physicians in surgical subspecialties (aOR: 4.51 95%; CI: 3.34-6.09).
Conclusion: More than half of oral antimicrobial prescriptions in the ED were inappropriate. Unnecessary or inappropriate antimicrobial prescriptions were frequently issued during the late-night shift, and by older physicians and physicians in surgical subspecialties.
S. Miyahara, None
A. Orihara, None
Y. Uehara, None
K. Hiramatsu, None
H. Honda, None