ABSTRACT
Primary care antimicrobial stewardship program (ASP) interventions can reduce the over-prescription of unnecessary antibiotics, but the impact on the reduction in bacterial resistance is less known, and there is a lack of available data. We implemented a prolonged educational counseling ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, which was compared to a pre-intervention period, a significant reduction in antibiotic prescriptions occurred, particularly those associated with greater harmful effects and resistance selection. There was also a decrease in methicillin-resistant Staphylococcus aureus (MRSA) strains and in their co-resistance to other antibiotics, particularly those with an ecological impact.
ABSTRACT
Introducción. Los criterios de alarma permiten identificar a las personas que consultan por cefaleas secundarias graves en los servicios de urgencias. Objetivo. Determinar las características sociodemográficas de los pacientes que acuden a urgencias por cefalea, la incidencia de criterios de alarma, el tratamiento y el diagnóstico tras un año de seguimiento. Pacientes y métodos. Estudio transversal retrospectivo y observacional de personas atendidas en el servicio de urgencias del Hospital Arnau de Vilanova entre junio de 2014 y mayo de 2015 por cefalea. Resultados. Se identificó a un total de 303 personas, de las cuales 165 se incluyeron finalmente en el estudio. Hubo un predomino de mujeres (66,7%). La edad media fue de 41,2 ± 15,9 años. Sólo un 16,4% fue derivado desde atención primaria y 52 (31,5%) presentaban criterios de alarma. En la mitad de estos casos se realizó una tomografía computarizada craneal, y en 4 (7,7%), una punción lumbar. Se identificó una causa grave de la cefalea en 4 casos (2,4%). Tras un año de seguimiento, tres pacientes que inicialmente no consultaron por criterios de alarma fueron diagnosticados de enfermedades graves del sistema nervioso central, y 23 (13,9%) volvieron a urgencias por el mismo motivo. Conclusiones. Sólo uno de cada dos pacientes cumple criterios de alarma. La proporción de cefalea secundaria grave es realmente baja. Es necesario mejorar el abordaje multidisciplinar de la cefalea en nuestro ámbito para evitar la consulta a urgencias por cefaleas primarias sin criterios de alarma
Introduction. Alarm criteria make it possible to identify persons who visit emergency services because of severe secondary headaches. Aims. To determine the socio-demographic characteristics of the patients who visit emergency departments due to headache, the incidence of alarm criteria, treatment and the diagnosis after one years follow-up. Patients and methods. We conducted a retrospective observational cross-sectional study of the persons attended in the emergency department of the Arnau de Vilanova Hospital between June 2014 and May 2015 due to headache. Results. A total of 303 persons were identified, of whom 165 were finally included in the study. There was a predominance of women (66.7%). The mean age was 41.2 ± 15.9 years. Only 16.4% were referred from primary care and 52 (31.5%) presented alarm criteria. A computerised tomography head scan was performed in half of these cases, and lumbar puncture was carried out in four of them (7.7%). A serious cause of headache was found in four cases (2.4%). After one year of follow-up, three patients who did not initially visit because of alarm criteria were diagnosed with severe diseases of the central nervous system, and 23 (13.9%) returned to the emergency department for the same reason. Conclusions. Only one out of every two patients meets the alarm criteria. The proportion of severe secondary headache is really low. The multidisciplinary management of headache needs to be improved in our setting to prevent people visiting the emergency department due to primary headaches without any alarm criteria
