Efecto de la inadecuación de la antibioterapia en Urgencias sobre la eficiencia en la hospitalización / Effect of the inadequacy of antibiotic therapy in the Emergency Department on hospital stays

INTRODUCCIÓN: El objetivo principal fue determinar la frecuencia de pacientes que reciben terapia antibiótica inapropiada y evaluar los resultados en términos de estancia media, reingreso y mortalidad a 30 días. MÉTODOS: Estudio observacional de cohortes retrospectivo que incluyó a todos los pacientes ingresados por infección desde un Servicio de Urgencias (SU) durante un mes. Se recogieron variables demográficas, comorbilidad, factores de riesgo de multirresistencia, foco de infección, resultados microbiológicos y antibiótico prescrito en el SU. Las variables de resultado fueron el tiempo de estancia, y la mortalidad y el reingreso a 30 días. RESULTADOS: Se incluyeron 376 pacientes con una edad media de 71,1 (DE 21) años. Las infecciones más frecuentes fueron respiratoria (45,7%) y urinaria (23,9%). El número de pacientes con una estancia superior a la mediana (≥9 días), reingreso y mortalidad a los 30 días fue de 165 (46,1%), 74 (19,7%) y 44 (11,7%) pacientes, respectivamente. La prescripción inapropiada del tratamiento antibiótico en el SU se produjo en 42 (11,2%) casos. Tras ajustar por los datos demográficos, la comorbilidad, los factores de riesgo para patógenos resistentes, la presencia de sepsis en el SU y el foco de infección, la prescripción inapropiada se asoció a una estancia prolongada (OR 2,22; IC95% 1,07-4,60; p = 0,032), pero no a un aumento de la mortalidad (p = 0,271) o de los reingresos (p = 0,784) a los 30 días. CONCLUSIÓN: La prescripción inapropiada del tratamiento antibiótico empírico en los pacientes ingresados por un proceso infeccioso desde el SU provoca una estancia prolongada, pero no un incremento de la mortalidad o del reingreso

INTRODUCTION: The main objective of the study was to determine the frequency of patients receiving inappropriate empiric antibiotic therapy and to assess the impact in terms of increase length of hospital stay, 30-day re-admissions, and 30-day mortality. METHODS: An observational retrospective cohort study was conducted over a one-month period that included all patients hospitalised from an Emergency Department (ED) due to infection. Demographic variables, comorbidity, multi-resistance risk factors, site of infection, microbiological findings, and antibiotic prescribed in ED were collected. Outcomes were length of hospital stay, 30-day re-admissions, and 30-day mortality. RESULTS: A total of 376 patients were included, with a mean age of 71.1 (SD 21) years. The most frequent causes were respiratory (45.7%) and urine (23.9%) infections. The number of patients with length of stay over the median (≥9 days) was 165 (46.1%), with re-admissions 74 (19.7%), and mortality at 30 days 44 (11.7%). There was inappropriate antibiotic treatment in 42 (11.2%) cases. After adjusting for demographic data, comorbidity, risk factors for multidrug resistant organism, presence of sepsis criteria in ED, and site of infection, inappropriate treatment was associated with an extended length of hospital stay (OR 2.22; 95% CI; 1.07-4.60; P=.032), but did not to an increase in mortality (P=.271) or re-admission (P=.784) at 30 days. CONCLUSION: The inappropriate empirical antibiotic therapy in patients admitted from the ED leads to an extended hospital stay, but did not increase mortality or readmission

Effect of the inadequacy of antibiotic therapy in the Emergency Department on hospital stays. / Efecto de la inadecuación de la antibioterapia en Urgencias sobre la eficiencia en la hospitalización.

INTRODUCTION: The main objective of the study was to determine the frequency of patients receiving inappropriate empiric antibiotic therapy and to assess the impact in terms of increase length of hospital stay, 30-day re-admissions, and 30-day mortality. METHODS: An observational retrospective cohort study was conducted over a one-month period that included all patients hospitalised from an Emergency Department (ED) due to infection. Demographic variables, comorbidity, multi-resistance risk factors, site of infection, microbiological findings, and antibiotic prescribed in ED were collected. Outcomes were length of hospital stay, 30-day re-admissions, and 30-day mortality. RESULTS: A total of 376 patients were included, with a mean age of 71.1 (SD 21) years. The most frequent causes were respiratory (45.7%) and urine (23.9%) infections. The number of patients with length of stay over the median (≥9 days) was 165 (46.1%), with re-admissions 74 (19.7%), and mortality at 30 days 44 (11.7%). There was inappropriate antibiotic treatment in 42 (11.2%) cases. After adjusting for demographic data, comorbidity, risk factors for multidrug resistant organism, presence of sepsis criteria in ED, and site of infection, inappropriate treatment was associated with an extended length of hospital stay (OR 2.22; 95% CI; 1.07-4.60; P=.032), but did not to an increase in mortality (P=.271) or re-admission (P=.784) at 30 days. CONCLUSION: The inappropriate empirical antibiotic therapy in patients admitted from the ED leads to an extended hospital stay, but did not increase mortality or readmission.