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Adherence to guidelines on empiric use of antibiotics in the emergency room.

机译：遵守急诊室经验性使用抗生素的准则。

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BACKGROUND: In October 2002, guidelines for empiric antibiotics in emergency room (ER) were introduced. AIMS: To evaluate physician's compliance with guidelines and their utility in improving patient care. METHODS: Reviewing charts of patients admitted to ER during October 4, 2004 to February 14, 2005 with suspected infection, subsequently hospitalized to internal medicine ward. Along with demographic data, the following parameters were recorded: Initiating antibiotics in ER, according-to-guidelines treatment (ATGT), lag-time between admittance and first antibiotic dose, diagnosis, proper coverage of pathogens by treatment (PCPT), and outcome. RESULTS: A total of 534 patients were admitted to ER with a suspected infection, 481 (90.1%) of them were managed according to guidelines, and from the 431 patients (80.7%) who received antibiotics, 381 (88.4%) were given ATGT. In 105 cases (19.7%), positive cultures (urine or blood) were obtained: 23.6% and 30.0% of the patients who received ATGT and not-ATGT, and the given antibiotic ensured proper coverage of the pathogen which grew in 73.3% and 46.7% of the cases, respectively. Percentages of good outcome (staying alive) for ATGT, non-ATGT, PCPT, and not-PCPT were 92.1%, 76.0%, 89.0%, and 69.0%, respectively. By multivariate analysis, early ATGT proved to be related to good outcome. CONCLUSIONS: Physicians' compliance with hospital guidelines to empiric antibiotics in ER was high. Adherence to guidelines was associated with a better outcome. Local susceptibility patterns to antibiotics need to be actively monitored. Prompt administration of antibiotics in the ER is likely to have a favorable outcome on survival, yet larger studies are required to establish this conclusively.
机译：背景：2002年10月，引入了急诊室（ER）的经验性抗生素指南。目的：评估医师对指南的依从性及其在改善患者护理方面的效用。方法：回顾性分析2004年10月4日至2005年2月14日期间因怀疑感染而入院并随后住院的内科病房患者的病历。连同人口统计数据一起，记录了以下参数：急诊室中的抗生素起始，按指南治疗（ATGT），准入和首次抗生素剂量之间的滞后时间，诊断，通过治疗适当覆盖病原体（PCPT）和结果。结果：总共534例疑似感染的ER患者入院，其中481例（90.1％）按指南进行治疗，在431例接受抗生素治疗的患者（80.7％）中，381例（88.4％）接受了ATGT 。在105例（19.7％）患者中，获得了阳性培养物（尿液或血液）：分别接受ATGT和非ATGT的患者分别占23.6％和30.0％，并且给定的抗生素可确保适当覆盖病原体，其中病原体的生长率分别为73.3％和分别为46.7％。 ATGT，非ATGT，PCPT和非PCPT的良好结果（存活率）分别为92.1％，76.0％，89.0％和69.0％。通过多变量分析，证明早期ATGT与良好的结局有关。结论：内科医师对医院经验性抗生素的医院指南依从性很高。遵守准则可以带来更好的结果。需要积极监测对抗生素的局部敏感性模式。在急诊室中及时使用抗生素可能对生存产生有利的结果，但仍需进行更大的研究才能得出结论。

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