Modification of Empirical Antimicrobial Regimen During the First 72 Hours of Hospitalization

Márquez-Saavedra, E.; Corzo Delgado, J.E.; Artacho, S.; Gómez-Mateos, J.

doi:10.1016/S2173-5085(08)70042-X

Farmacia Hospitalaria

ISSN: 1130-6343

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All 14-year-old patients admitted to the Emergency Department who were started on antibiotic therapy and subsequently were hospitalized for at least 72 hours in an in-patient hospital ward, were included in a prospective observational study. Patients underwent daily follow-up during the first 3 days of hospitalization. The type of infection, microbiological data, and empirical antibiotic therapy and its changes were registered.

Results

225 patients were included in this study. The most frequent types of infection diagnosed were infection of the respiratory airways, pneumonia, and skin and soft-tissue infection. Amoxicillin-clavulanic acid was the most widely prescribed antibiotic followed by levofloxacin and third generation cephalosporins. Microbiological samples were taken in 80 (36%) patients. Of the 225 antimicrobial regimens started in the Emergency Department, 94 (42%) were changed during the first 72 hours of hospitalization: 37 (16%) were completely modified, 31 (14%) were discontinued and antibiotics were added or stopped from the existing regimen in 26 cases (12%). Among these 94 patients whose treatment was changed, only in 40 (42%) there was a microbiological result for aiding in the adjustment of the antibiotic therapy.

Conclusion

The frequency of early changes during inpatient hospitalization to antimicrobial regimens which were initially prescribed in the Emergency Department is high. Microbiological results were rarely used to guide these changes.

Key words:

Anti-bacterial agents

Hospital emergency service

Drug use

Inpatients

Objetivo

Los objetivos del presente estudio fueron describir la modificación que se realiza de la antibioterapia empírica indicada a los pacientes ingresados desde el área de urgencias en los primeros días de estancia en la planta de hospitalización y conocer las características de dicho tratamiento antibiótico.

Método

Estudio prospectivo y observacional en el que se incluyó a pacientes mayores de 14 años que ingresaron desde el área de urgencias con al menos un antibiótico prescrito y tuvieron una hospitalización de al menos 72h. Se realizó un seguimiento diario de cada caso durante los primeros 3 días de hospitalización, documentando el tipo de infección diagnosticada, los datos microbiológicos y la antibioterapia empírica prescrita y sus modificaciones.

Resultados

Se incluyó a 225 pacientes. Los diagnósticos más frecuentes fueron infección respiratoria, neumonía e infección de la piel y los tejidos blandos, y los antibióticos más empleados fueron amoxicilinaácido clavulánico, levofloxacino y cefalosporinas de tercera generación. Se solicitó al menos un tipo de muestra microbiológica a 80 enfermos (36%). De las 225 pautas antibióticas prescritas en urgencias, 94 (42%) fueron modificadas durante las primeras 72h de hospitalización: 37 (16%) pautas se cambiaron por completo, 31 (14%) se suspendieron totalmente y en 26 (12%) se añadió o suspendió algún antimicrobiano, aunque sólo en 40 de ellas (42%) se dispuso de cultivos para dirigir el tratamiento.

Conclusiones

La frecuencia con la que las pautas antimicrobianas prescritas en urgencias se modificaron durante los primeros días de estancia en la planta de hospitalización es elevada, y destaca la escasa utilización de los resultados microbiológicos para realizar estos cambios.

Palabras clave:

Antibacterianos

Servicio de urgencias hospitalario

Utilización de fármacos

Pacientes ingresados

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☆

This study has been presented as a poster in the III Conference of the Andalusian Society of hospital Pharmacy in Úbeda in March 2006 and communicated orally in the XII Conference of the Spanish Society of Infectious Diseases and Clinical Microbiology in Valencia in May 2006.

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