Adequacy of the special category antibiotics prescriptions in the Emergency Department of a third level urban Hospital

espanolObjetivo. Analizar la adecuacion de las prescripciones de antibioticos de categoria especial (ATB de CE) en el Servicio de Urgencias Hospitalario (SUH) de un centro urbano de tercer nivel. Material y metodos. Se selecciono una muestra aleatoria de 100 pacientes diferentes a los que se les inicio un ATB de CE en Urgencias durante el ano 2018. El equipo investigador reviso la historia clinica del episodio de urgencias y de ingreso. Se determino mediante regresion logistica los factores independientes asociados con el grado de adecuacion del tratamiento. Resultados. Se analizaron 97 prescripciones de las cuales 66 (68%) cumplian los criterios de prescripcion adecuada. El grado de adecuacion fue del 70% si la infeccion estaba relacionada con la asistencia sanitaria y del 75% si el paciente tenia factores de riesgo de infeccion por microorganismos multirresistentes (MMR). El porcentaje de adecuacion fue mayor en los casos en los que se especifico el foco de la infeccion (72%) y la gravedad del episodio (73%). Las variables independientes que se asociaron a una prescripcion adecuada fueron: la presencia de factores de riesgo de infeccion por MMR (OR: 2,35 IC 95%: 1,65 – 3,17 p: 0,01), el especificar el foco de la infeccion (OR: 3,79 IC 95%: 1,72 – 4,22 p: 0,02) y senalar la gravedad del episodio (OR: 3,09 IC 95%: 1,12 – 3,09 p: 0,03). Conclusiones. La prescripcion de los ATB de CE en el SUH es adecuada en la medida que se tenga en cuenta el ambito de adquisicion de la infeccion, los factores de riesgo de MMR, el foco de infeccion y la gravedad del cuadro clinico. EnglishObjective. The aim of the study was to analyze the adequacy of the special category antibiotics prescriptions in the Emergency Department (ED) of a third level urban Hospital. Material and methods. A random sample of 100 different patients who were started with a special category antibiotic along 2018 in the ED was selected. The research team reviewed the medical history of the emergency and admission episode. The independent factors associated with the degree of adequacy of the treatment were determined by logistic regression. Results. A total of 97 prescriptions were analyzed of which 66 (68%) met the criteria of adequate prescription, 23 (24%) adequate prescription, but with equally recommended alternatives and 8 (8%) were inappropriate prescriptions. The degree of adequacy was 70% if the infection was related to healthcare and 75% if the patient had risk factors for multiresistant (MR) microorganisms’ infection. The percentage of adequacy was higher in the cases in which the focus of the infection (72%) and the severity of the episode (73%) were specified. The independent variables that were associated with an adequate prescription were: the presence of risk factors for MR microorganisms’ infection (OR: 2.35 95% CI: 1.65 - 3.17 p: 0.01), if the focus of the infection (OR: 3.79 95% CI: 1.72 - 4.22 p: 0.02) and the severity of the episode (OR: 3.09 95% CI: 1.12 - 3.09 p: 0.03) were specified. Conclusions. The prescription of special category antibiotics in ED is appropriate if the clinical guidelines are followed and if the setting of infection acquisition, the risk factors of MR microorganisms, the focus and the severity of infection are taken into account in clinical picture.