Adherence to local antimicrobial guidelines for initial treatment of community-acquired infections.

INTRODUCTION Adherence to antimicrobial guidelines is key to ensuring a correct treatment of severe infections and to lessening misuse of broad-spectrum antimicrobials. We conducted a retrospective cross-sectional study at the Emergency Department of Aalborg University Hospital, North Denmark Region. Our aim was to examine adherence to local antimicrobial guidelines in the empirical treatment of community-acquired infections and to identity any predictors of guideline non-adherence. METHODS We identified 1,555 patients who had blood cultures performed and were admitted to the medical emergency department in 2016. We reviewed the medical charts of 755 patients and included those who received at least one antibiotic prescription within the first 24 hours of admission. We excluded patients with known immunodeficiency, severe renal failure or hospitalisation within the previous month. RESULTS Of the 383 included patients, 203 (53%) received guideline-concordant antibiotic treatment. The treatment was guideline-concordant in 41% of patients with suspected sepsis of unknown origin, in 44% with pneumonia and in 37% with urinary tract infections. Patients with underlying chronic obstructive pulmonary disease (25%) received guideline-concordant treatment significantly more often (83%, p < 0.01) than other groups. CONCLUSIONS Adherence to local antimicrobial guidelines was not high. Further studies are needed to identify barriers to guideline adherence. FUNDING None. TRIAL REGISTRATION The study was registered with the Danish Data Protection Agency (R. no. 2008-58-0028).