1843. Prescribers’ characteristics and unnecessary/inappropriate antimicrobial prescription in the emergency department: an observational study at a tertiary care center
Session: Poster Abstract Session: Antimicrobial Stewardship: Outpatient Settings
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • IDWEEK Tagashira2018.pdf (77.6 kB)
  • Background: Antimicrobials are commonly prescribed in the emergency department despite the fact that a large proportion of these drugs are misused. However, comprehensive studies of factors leading to the misuse of antimicrobials in the emergency department (ED) are few. Understanding current practice of antimicrobial use in the ED is important for developing an effective antimicrobial stewardship program for this setting.

    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.

    Yasuaki Tagashira, MD.1, Naofumi Yamane, MD.1, Satoshi Miyahara, MD.1, Azusa Orihara, MD.1, Yuki Uehara, MD, PhD2, Keiichi Hiramatsu, MD, PhD3 and Hitoshi Honda, MD, PhD1, (1)Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan, (2)Department of Infection Control Science, Juntendo University Graduate School of Medicine, Tokyo, Japan, (3)Department of Infection Control Science, Juntendo University Faculty of Medicine, Tokyo, Japan

    Disclosures:

    Y. Tagashira, None

    N. Yamane, None

    S. Miyahara, None

    A. Orihara, None

    Y. Uehara, None

    K. Hiramatsu, None

    H. Honda, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.