High variability among Emergency Departments in 3rd-generation cephalosporins and fluoroquinolones use for community-acquired pneumonia
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Fluoroquinolones and 3rd-generation cephalosporins that are prescribed for pneumonia may be avoided and replaced by a penicillin in some cases. We aimed to determine if the proportion of patients treated for pneumonia with a cephalosporin, a fluoroquinolone or both varies among Emergency Departments (EDs), and to estimate the proportion of avoidable prescriptions.
This was a retrospective study of patients treated for pneumonia in eight French EDs, and subsequently hospitalized in non-ICU wards. Third-generation cephalosporins or respiratory fluoroquinolones were presumed unavoidable if they met both criteria: (1) age ≥65 years or comorbid condition; and (2) allergy or intolerance to penicillin, or failure of penicillin, or previous treatment with penicillin, or for fluoroquinolones only, suspected legionellosis.
We included 832 patients. Thirty-four percent (95 % CI, 31–38 %) of patients were treated with a cephalosporin, a respiratory fluoroquinolone or both (range among EDs 19–44 %). Four EDs were independent risk factors for prescription of a cephalosporin, a fluoroquinolone or both [adjusted OR, 2.27 (1.64–3.15)], as were immune compromise [aOR 2.54 (1.56–4.14)], antibacterial therapy started before arrival in the ED [aOR 3.32 (2.30–4.81)], REA-ICU class III or IV [aOR 1.93 (1.15–3.23)], PSI class V [aOR 1.49 (1.00–2.20)], fluid ressuscitation [aOR 3.98 (2.49–6.43)] and non-invasive ventilation in the ED [aOR, 7.18 (1.7–50.1)]. Treatment with a cephalosporin, a fluoroquinolone or both was avoidable in 67 % (62–73 %) of patients.
Cephalosporins and fluoroquinolones use in pneumonia is highly variable among EDs. The majority of these prescriptions are avoidable. Antibiotic stewardship programs should be implemented to restrict their use in EDs.
KeywordsCommunity-acquired pneumonia Antibiotic prescription Prudent use Cephalosporins Fluoroquinolones Emergency department
The authors acknowledge Jacques Choukroun, Philippe Fradin, Christophe Legal, Betty Mazet, Amélie Pichot, Bruno Poujol and Rachid Yousfi for helping local investigators.
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by the ethics committee of Centre Hospitalier Universitaire de Nantes (Number 2014-04-01).
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