Elkharrat, D., Brun-Ney, D., Cordier, B., Goldstein, F., Péan, Y., Sanson-Le-Pors, M.J., Viso, P.M., Zarka, M., Debatisse, A., Scheimberg, A., and Pecking, M.
Background. – In emergency department (ED) the prevalence of infectious diseases is high but anti-microbial drugs are misused.Objective. – The authors had for aim to identify antibiotic use, defined either as a first prescription (FP), interruption (IP), replacement (RP), or continuation (CP) of a previous antibiotic.Methods. – Patients, 18 years of age or more, were included if 1) FP, or IP, or RP, or CP was decided 2) they agree to a telephone follow-up at day 3. They were sorted in 5 categories according to a pre-test evaluation of disease acuteness (PDA) published in 1994, in order to compare them to the standard French EW patient.Results. – From December 11 to December 24, 2000, 33 of the 34 EWs reported 38,859 patients; 21,909 were non-trauma patients and 2,326 (11.2%) who were presumed to be infected were given an antibiotic in 77.3% of the cases. Extrapolated to all 34 EWs, infectious diseases prevalence would be 12.86% of non-trauma patients. The 34 EWs included 1,981 patients, aged 52 ± 24 years. FP was prescribed in 77.3%, RP in 14.5%, CP in 5% and IP in 3.2%. The main infections were respiratory (37.4%), urinary (20.4%), skin (18.6%), and ENT (12%). The major antibiotics used were penicillins (57.2%), fluoroquinolones (20.8%), and 3GC (10.4%). The patients’PDA differed significantly from that of the standard French EW patient (p<10–4). One thousand and eighty-nine (55%) were hospitalized. One thousand and eight-hundred-twenty were followed-up, with 1.4% reported dead, 3.9% who did not comply, and 23.2% whose antibiotic therapy was modified by a physician. [Copyright &y& Elsevier]