Abstract
Antibiotic resistance is increasing worldwide. The implementation of antibiotic stewardship programmes (ASPs) is of utmost importance to optimize antibiotic use in order to prevent resistance development without harming patients. The emergency department (ED), cornerstone between hospital and community, represents a crucial setting for addressing ASP implementation; however, evidence data on ASP in ED are poor. In this study, a 4-year, non-restrictive, multi-faceted ASP was implemented in a general ED with the aim to evaluate its impact on antibiotic use and costs. Secondly, the study focused on assessing the impact on length of hospital stay (LOS), Clostridioides difficile infection (CDI) incidence rate, and mortality in the patients’ group admitted from ED to medical wards. The ASP implementation was associated with a reduction of antibiotic use and costs. A mild but sustained LOS decrease in all medical wards and a significant downward trend of CDI incidence rate were observed, while mortality did not significantly change. In conclusion, the implementation of our ED-based ASP has demonstrated to be feasible and safe and might clinically benefit the hospital admitted patients’ group. Further research is needed to identify the most suitable ASP design for ED and the key outcome measures to reliably assess its effectiveness.
Highlights
The antibiotic stewardship programmes (ASPs) implementation has determined an overall decrease of length of hospital stay (LOS) of the inpatients group admitted in all the five medical wards throughout the study phases
Our study demonstrated that a 4-year non-restrictive multifaceted ASP program applied in emergency department (ED) setting may reduce the overall antibiotic use without adversely affecting mortality
The ASP implementation was associated with a significant decrease of the antibiotic costs by two thirds after the intervention; starting from 691.5 euro per 100 patient days in the pre-intervention phase, the cost has decreased quickly by two thirds in the following phases
Summary
The statement underlined the need to shift attention to EDs to define which of the multiple antibiotic stewardship strategies are most feasible in this setting[7] In this context, the Centers for Disease Control and prevention promoted the development of the MITIGATE toolkit (A Multifaceted Intervention to Improve Prescribing for Acute Respiratory Infection for Adults and Children in Emergency Department and Urgent Care Settings), a six-core component framework for implementing non-restrictive intervention (mostly education and audit and feedback) in the ED13. The Centers for Disease Control and prevention promoted the development of the MITIGATE toolkit (A Multifaceted Intervention to Improve Prescribing for Acute Respiratory Infection for Adults and Children in Emergency Department and Urgent Care Settings), a six-core component framework for implementing non-restrictive intervention (mostly education and audit and feedback) in the ED13 Besides this example, very few guidance documents are available on this topic. The secondary aim was to evaluate the clinical impact of the ED-based ASP intervention on the hospital-admitted patients’ group
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