title: Effect of the inadequacy of antibiotic therapy in the Emergency Department on hospital stays.
abstract: BACKGROUND
  The main objective of the study was to determine the frequency of patients receiving inappropriate empiric antibiotic therapy and to assess the impact in terms of increase length of hospital stay, 30-day re-admissions, and 30-day mortality.
  
  
  METHODS
  An observational retrospective cohort study was conducted over a one-month period that included all patients hospitalised from an Emergency Department (ED) due to infection. Demographic variables, comorbidity, multi-resistance risk factors, site of infection, microbiological findings, and antibiotic prescribed in ED were collected. Outcomes were length of hospital stay, 30-day re-admissions, and 30-day mortality.
  
  
  RESULTS
  A total of 376 patients were included, with a mean age of 71.1 (SD 21) years. The most frequent causes were respiratory (45.7%) and urine (23.9%) infections. The number of patients with length of stay over the median (≥9 days) was 165 (46.1%), with re-admissions 74 (19.7%), and mortality at 30 days 44 (11.7%). There was inappropriate antibiotic treatment in 42 (11.2%) cases. After adjusting for demographic data, comorbidity, risk factors for multidrug resistant organism, presence of sepsis criteria in ED, and site of infection, inappropriate treatment was associated with an extended length of hospital stay (OR 2.22; 95% CI; 1.07-4.60; P=.032), but did not to an increase in mortality (P=.271) or re-admission (P=.784) at 30 days.
  
  
  CONCLUSIONS
  The inappropriate empirical antibiotic therapy in patients admitted from the ED leads to an extended hospital stay, but did not increase mortality or readmission.
authors.affiliation: Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, España. Electronic address: jgonzalezcast@gmail.com.
authors.forename: Juan
authors.initials: J
authors.lastname: González-Del Castillo
authors.affiliation: Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, España.
authors.forename: Clara
authors.initials: C
authors.lastname: Domínguez-Bernal
authors.affiliation: Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, España.
authors.forename: María Cristina
authors.initials: MC
authors.lastname: Gutiérrez-Martín
authors.affiliation: Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, España.
authors.forename: María José
authors.initials: MJ
authors.lastname: Núñez-Orantos
authors.affiliation: Servicio de Microbiología Clínica, Hospital Clínico San Carlos, Madrid, España.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Candel
authors.affiliation: Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, España.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Martín-Sánchez
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Adecuación; Adequacy; Antibiotic; Antibiótico; Emergency; Inappropriate treatment; Infección; Infection; Tratamiento inapropiado; Urgencias