Antibiotic therapy in the emergency room: Optimal prescription is indeed the best

INTRODUCTION

Emergency departments (ED) are pivotal for antibiotic prescription, of which the appropriateness and consequences have rarely been assessed.

METHODS

A retrospective study included patients referred to the ED and hospitalized with an advocated diagnosis of infection. Day-0 (ED initial prescription) and day-2 (reevaluation) antibiotic therapies were graded as optimal (if fully following the guidelines in terms of molecule, dose, and route of administration), adapted (if the prescribed molecule was microbiologically active but not recommended as first-line treatment, or in case of a wrong dose), or inadequate (other situations). The primary endpoint was onset of an unfavorable event (death, transfer to intensive care unit, or re-hospitalization). Prognosis factors associated with survival without unfavorable event were assessed by multivariate analysis.

RESULTS

We included 484 patients. Optimal, adapted, and inadequate initial prescriptions concerned 328 (67.8 %), 110 (22.7 %) and 46 (9.5 %) patients respectively. Compared with an optimal prescription, an initial adapted prescription was associated with a poorer prognosis (HR = 1.95, CI95% [1.18-3.22]; p = 0.01). Reevaluation was performed in 436 (90.1 %) patients. After reevaluation, optimal, adapted, and inadequate prescriptions concerned 326 (74.8 %), 64 (14.7 %), and 46 (10.5 %) patients respectively. After reevaluation, and as compared with optimal prescription, inadequate prescription was significantly associated with unfavorable events (HR = 3.52, CI95% [1.42-8.72]; p = 0.003).

CONCLUSION

Antibiotics are frequently prescribed in EDs. Antibiotic prescription has got to be optimal, and not simply adapted, so as to be associated with significant clinical benefit.

Is there a need to widely prescribe antibiotics in patients hospitalized with COVID-19?

BACKGROUND

Debate continues regarding the usefulness and benefits of wide prescription of antibiotics in patients hospitalized with coronavirus disease 2019 (COVID-19).

METHODS

All patients hospitalized in the Infectious Diseases Department, Dijon University Hospital, Dijon, France between 27 February and 30 April 2020 with confirmed COVID-19 were included in this study. Clinical, biological and radiological data were collected, as well as treatment and outcome data. An unfavourable outcome was defined as death or transfer to the intensive care unit. Patient characteristics and outcomes were compared between patients who did and did not receive antibiotic therapy using propensity score matching.

FINDINGS

Among the 222 patients included, 174 (78%) received antibiotic therapy. The univariate analysis showed that patients who received antibiotic therapy were significantly older, frailer and had more severe presentation at admission compared with patients who did not receive antibiotic therapy. Unfavourable outcomes were more common in patients who received antibiotic therapy [hazard ratio (HR) 2.94, 95% confidence interval (CI) 1.07-8.11; P = 0.04]. Multi-variate analysis and propensity score matching indicated that antibiotic therapy was not significantly associated with outcome (HR 1.612, 95% CI 0.562-4.629; P = 0.37).

CONCLUSION

Antibiotics were frequently prescribed in this study and this was associated with more severe presentation at admission. However, antibiotic therapy was not associated with outcome, even after adjustment. In line with recent publications, such data support the need to streamline antibiotic therapy in patients with COVID-19.