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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.
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Details
1 Division of Infectious Diseases, Department of Internal Medicine I, German Center for Infection Research, University of Tübingen, Tübingen, Germany (GRID:grid.10392.39) (ISNI:0000 0001 2190 1447); Division of Infectious Diseases, Department of Diagnostic and Public Health, G. B Rossi University Hospital, University of Verona, Verona, Italy (GRID:grid.5611.3) (ISNI:0000 0004 1763 1124)
2 Division of Infectious Diseases, Department of Internal Medicine I, German Center for Infection Research, University of Tübingen, Tübingen, Germany (GRID:grid.10392.39) (ISNI:0000 0001 2190 1447); Medical Department, Division of Nephrology and Internal Intensive Care Medicine, Charitè, Berlin, Germany (GRID:grid.6363.0) (ISNI:0000 0001 2218 4662)
3 Division of Emergency Medicine, Department of Internal Medicine I, University of Tübingen, Tübingen, Germany (GRID:grid.10392.39) (ISNI:0000 0001 2190 1447)
4 Division of Infectious Diseases, Department of Internal Medicine I, German Center for Infection Research, University of Tübingen, Tübingen, Germany (GRID:grid.10392.39) (ISNI:0000 0001 2190 1447)
5 Division of Infectious Diseases, Department of Diagnostic and Public Health, G. B Rossi University Hospital, University of Verona, Verona, Italy (GRID:grid.5611.3) (ISNI:0000 0004 1763 1124)
6 Division of Infectious Diseases, Department of Internal Medicine I, German Center for Infection Research, University of Tübingen, Tübingen, Germany (GRID:grid.10392.39) (ISNI:0000 0001 2190 1447); Institut for Microbiology, Virology and Hygiene, University Hospital Rostock, Rostock, Germany (GRID:grid.413108.f) (ISNI:0000 0000 9737 0454)
7 Division of Infectious Diseases, Department of Internal Medicine I, German Center for Infection Research, University of Tübingen, Tübingen, Germany (GRID:grid.10392.39) (ISNI:0000 0001 2190 1447); Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy (GRID:grid.416422.7) (ISNI:0000 0004 1760 2489)
8 Medical Direction, G. B Rossi University Hospital, University of Verona, Verona, Italy (GRID:grid.5611.3) (ISNI:0000 0004 1763 1124)
9 Department of Gastroenterology, Hepatology and Infectious Diseases, Tübingen University Hospital, Tübingen, Germany (GRID:grid.411544.1) (ISNI:0000 0001 0196 8249)