title: Use of broad-spectrum antibiotics in French EDs: different trends for third-generation cephalosporins and fluoroquinolones.
abstract: OBJECTIVE
  Third-generation cephalosporins and fluoroquinolones are particularly prone to promoting bacterial resistance. Their use in Emergency Departments (EDs) is poorly known. Our objectives were to assess the use of antibacterial agents in French EDs.
  
  
  METHODS
  This study is a retrospective study of antibiotics delivered to the adult units of 11 EDs of French academic centres in 2012, and to six of these EDs between 2009 and 2012.
  
  
  RESULTS
  The total antibiotic use was 66.4 defined daily doses (DDD)/1000 ED visits in 2012, and it increased between 2009 and 2012 (yearly estimate, +1.8±0.9 DDD/1000 ED visits, P=0.048). The 3GC-FQ class, which grouped third-generation cephalosporins and fluoroquinolones, accounted for 39.2% of the total antibiotic use, and the use of this class of antibiotics was highly variable among EDs (range, 31.6-49.5% of total antibiotic use). The aminopenicillin and β-lactamase inhibitor/3GC-FQ ratio varied among EDs [median (range), 0.91 (0.52-1.25)]. Between 2009 and 2012, there was a significant decrease in the use of the 3GC-FQ class (yearly estimate, -0.8±0.4% of total antibiotic use), antipneumococcal fluoroquinolones (-0.8±0.3%) and other fluoroquinolones (-0.9%±0.3%), and there was a significant increase in the use of third-generation cephalosporins (+0.7±0.3%), aminoglycosides (+0.4±0.1%), imidazole derivatives (+0.4±0.1%) and lincosamides (+0.1±0.0%).
  
  
  CONCLUSIONS
  Fluoroquinolones and third-generation cephalosporins are widely used in the ED. Their use is highly variable among EDs. Third-generation cephalosporins were increasingly used between 2009 and 2012, whereas the use of fluoroquinolones decreased. Reduced use of cephalosporins in the ED, without increasing fluoroquinolone use, should be aimed at through antibiotic stewardship programs.
authors.affiliation: aEmergency Department bPharmacy cDepartment of Microbiology and Infection Control, Nantes University Hospital dClinical and experimental therapeutics of infections eLaboratory of Mathematics Jean Leray, University of Nantes, Nantes fCentre Henri Lebesgue, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Batard
authors.forename: Marie-Anne
authors.initials: MA
authors.lastname: Vibet
authors.forename: Cathelle
authors.initials: C
authors.lastname: Lemarchand
authors.forename: Dominique
authors.initials: D
authors.lastname: Navas
authors.forename: Didier
authors.initials: D
authors.lastname: Lepelletier
authors.forename: Gilles
authors.initials: G
authors.lastname: Potel
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Montassier
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D024841:Fluoroquinolones / Q000627:therapeutic use*; D005602:France; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones