A new look on Staphylococcus bloodstream infections

were decided by residents. The most diagnosed infections were urinary tract infection (UTI) (17.7%), community acquired pneumonia (CAP) (16.3%) and tonsillitis (11.5%). Antibiotics were prescribed in 6.2% of noninfectious diagnoses. Monotherapy prescriptions accounted for 81.3% of the cases: 41.7% of penicillins and 21.6% of quinolones. For UTI, the most frequently prescribed antibiotics were quinolones (37.5%), sulfonamides (22.2%) and penicillins (20.8%); regarding CAP, quinolones (28.1%) and penicillins (21.9%) were also the preferred options. For tonsillitis, prescribers chose mainly penicillins (76.1%) and macrolides (10.9%). Combined antibiotherapy represented 14.4% of the prescriptions and it was the option in almost half (42.6%) of CAP prescriptions: the most frequent association was penicillin/ cephalosporin and macrolide (23.5%). Most patients were discharged; however, 26.6% were admitted to internal medicine wards, 70.3% of them because of lower respiratory tract infections. The antibiotherapy prescribed at the EDwasmaintained in 80.2% until the discharge. There were 51.3% of appropriate prescriptions: 69.4% for UTI, 58.7% for tonsillitis and 45.3% for CAP. Conclusions: We concluded that almost half of the antibiotic prescriptions at the ED were inappropriate for the established diagnosis, according to the available guidelines. However, ED misdiagnosis was not possible to exclude. In patients admitted to the internal medicine ward, the nondescalation of the large spectrum antibiotherapy prescribed at the ED was an additional example of discordance between daily practices and national recommendations. We also unraveled some of the predictive factors for antibiotic prescription appropriateness. Improving appropriate antibiotic therapy at the emergency department reveals that it is an essential step towards healthcare quality.