CP-199 Prescription of QUINOLONES, carbapenems and ANTI-MRSA agents in the emergency department of a district hospital: interventions and development over 3 years

Background Emergency departments (ED) are excellent places for implementation of policies that promote rational use of antibiotics, considering that most empiric antibiotherapies start at this level of care and tend to be maintained through hospitalisation. This is a paper-free hospital, with an electronic system capable of controlling antibiotic prescription, resulting in real time automatic notifications, whenever there is a mismatch between the chosen antibiotic and the context (infection or targeted) prophylaxis, or whenever conditioned prescription agents are prescribed, allowing a rapid onset of antibiotic stewardship. Purpose Assessment of the trend in the use of quinolones, carbapenems and anti-MRSA agents in patients admitted to the ED, based on sampling in March 2014, March 2015 and March-2016. Material and methods Retrospective analysis of notifications generated by the conditioned antibiotic system during the referred period. Results In this period of time, the prescription system generated over 3 consecutive years, the following notifications: quinolones: 76/48/29 (62% reduction between 2014/2016); carbapenems: 36/40/20 (44% reduction) and anti-MRSA: 13/9/3 (77% reduction). Levofloxacin represented, respectively, 59%/65%/72% of the quinolones prescribed. For carbapenems, meropenem represented, respectively, 50%/85%/90%. Finally, with regard to anti-MRSA, reports were almost exclusively for vancomycin (respectively 100%/89%/100%). In this period, 2014/2015/2016, respectively, 882/878/906 hospitalisations were made via the ED (range from 2.7% in 2014–2016). Conclusion During this period, there was a significant overall reduction in the initial prescription of quinolones and anti-MRSA agents, and to a lesser extent carbapenems, in patients admitted via the ED, mainly because of an increase in the number of hospitalisations and growing incidence of gram negative ESBL producers from outside, limiting the reduction in the use of carbapenems. This development reflects the phased effort interventions, starting with pharmaceutical validation and intervention “in loco” (end of 2014), reinforced by the analysis of the notifications issued by the Group of Local Coordination for the Prevention and Control of Infections and Antimicrobial Resistance (GCL-PPCIRA) under antibiotic stewardship (early 2015), as well as training activities and awareness aimed at doctors. This project shows how it is possible to reduce very significantly the use of conditioned antibiotics through a concerted and multidisciplinary intervention, under antibiotic stewardship. No conflict of interest