[Use of antibiotics in emergency units: qualitative and quantitative assessment].
BACKGROUND
Most antibiotic therapies are initiated in the emergency unit (EU). To better understand the antibiotic consumption survey in this unit, we compared our results to two neighbor hospitals. This quantitative data was then compared to a quality assessment of antibiotic prescription (audit).


METHODS
The quantitative measure of antibiotic consumption (three markers: ceftriaxone, amoxicillin-clavulanate, and fluoroquinolones) based on the ratio DDD:1000 patient admitted in the EU was compared between one teaching hospital and the two neighbor hospitals. Qualitative measure: a retrospective clinical targeted audit of antibiotic prescriptions was performed. The compliance to guidelines for infection diagnosis and antibiotic treatment were assessed.


RESULTS
Antibiotic consumption: the survey showed a higher consumption of the three antibiotics in the teaching hospital, especially for amoxicillin-clavulanate (3.7-5.5 higher). Audit: 93 files of EU patients were reviewed; their mean age was 71 years (18-96). Diagnosis was conform to the expert opinion in 70% of cases. No antibiotic was really necessary in 20% of cases, and delay between hospitalization and antibiotic prescription was relevant only for 56% of patients. The most frequently prescribed antibiotics were betalactams (penicillins 43%, third generation cephalosporin 21%, and fluoroquinolones 22%). The choice was conform to local and national guidelines in 78% of justified prescribed antibiotherapy.


CONCLUSIONS
The qualitative assessment cannot explain the higher antibiotic consumption trend. The number of unjustified antibiotic prescriptions does not explain the variable antibiotic consumption.
Asseray
N
N
UPRES EA 38 26 thérapeutique clinique et expérimentale des infections, faculté de médecine, université de Nantes, 1, rue Gaston-Veil, 44000 Nantes, France. nasseray@chu-nantes.fr
Bleher
Y
Y
Poirier
Y
Y
Hoff
J
J
Boutoille
D
D
Bretonniere
C
C
Lombrail
P
P
Potel
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D019818:Clavulanic Acid / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D024841:Fluoroquinolones / Q000627:therapeutic use; D005602:France; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D055815:Young Adult
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D010406:Penicillins; D019818:Clavulanic Acid; D002443:Ceftriaxone; D000658:Amoxicillin