Is Procalcitonin-Guided Antibiotic Therapy Working in Emergency Department Outpatients?

A 3-month-old baby is brought to the paediatric emergency department by their parents because of a fever. You decide to check their inflammatory markers. Their C-reactive protein (CRP) level comes back as 20 mg/L. Does this affect whether or not you start antibiotic therapy? Does it influence your decision to admit or discharge the patient? CRP is a commonly used biochemical test and yet its use is constantly debated and challenged. We look at the current evidence and suggest the best way to use this test in clinical practice.

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Impact of time to antibiotic therapy on clinical outcome in patients with bacterial infections in the emergency department: implications for antimicrobial stewardship

Clinical Microbiology and Infection ◽

10.1016/j.cmi.2020.02.032 ◽

2020 ◽

Cited By ~ 5

Author(s):

P. Nauclér ◽

A. Huttner ◽

C.H. van Werkhoven ◽

M. Singer ◽

P. Tattevin ◽

...

Keyword(s):

Emergency Department ◽

Clinical Outcome ◽

Antibiotic Therapy ◽

Antimicrobial Stewardship ◽

Bacterial Infections

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Procalcitonin guided antibiotic therapy in patients presenting with fever in the emergency department

Journal of Infection ◽

10.1016/j.jinf.2014.04.009 ◽

2014 ◽

Vol 69 (4) ◽

pp. 410-412 ◽

Cited By ~ 2

Author(s):

M. Limper ◽

Y. van der Does ◽

D.P.M. Brandjes ◽

M.D. De Kruif ◽

P.P.M. Rood ◽

...

Keyword(s):

Emergency Department ◽

Antibiotic Therapy

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Dog Bite Injuries: Primary and Secondary Emergency Department Presentations—A Retrospective Cohort Study

The Scientific World JOURNAL ◽

10.1155/2013/393176 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 21

Author(s):

Carmen A. Pfortmueller ◽

Anastasios Efeoglou ◽

Hansjakob Furrer ◽

Aristomenis K. Exadaktylos

Keyword(s):

Public Health ◽

Emergency Department ◽

Antibiotic Therapy ◽

Retrospective Cohort ◽

Complex Problem ◽

Infectious Complications ◽

University Hospital ◽

Dog Bite ◽

Increased Risk ◽

Bite Injuries

Dog bites in humans are a complex problem, embracing both public health and animal welfare. The primary aim of this study is to examine primary and secondary presentations related to dog bite injuries in adults.Methods. We retrospectively assessed all adult patients admitted with a dog bite injury to the Emergency Department of Bern University Hospital.Results. A total of 431 patients were eligible for the study. Forty-nine (11.4%) of all patients were admitted with secondary presentations. Bites to the hands were most common (177, 41.1%). All patients (47, 100%) with secondary presentations were admitted because of signs of infection. The median time since the dog bite was 3.8 days (SD 3.9, range 1–21). Thirty-one patients had already been treated with antibiotic; coamoxicillin was the most common primary antibiotic therapy (27/47 patients, 57.4%). Patients with injuries to the hand were at increased risk of secondary presentations (OR 2.08, 95% CI 1.21–3.55,P<0.006).Conclusion. Dog bite injuries to the hands are a major problem. They often lead to infectious complications. Immediate antibiotic therapy should carefully be evaluated for each patient.

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Emergency department guideline concordance with respect to pneumonia antibiotic therapy: We can do better

Emergency Medicine Australasia ◽

10.1111/1742-6723.12197 ◽

2014 ◽

Vol 26 (2) ◽

pp. 210-210 ◽

Cited By ~ 1

Author(s):

Stephen J Naughtin

Keyword(s):

Emergency Department ◽

Antibiotic Therapy

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Effect of the inadequacy of antibiotic therapy in the Emergency Department on hospital stays

Enfermedades infecciosas y microbiologia clinica (English ed ) ◽

10.1016/j.eimce.2017.03.004 ◽

2017 ◽

Vol 35 (4) ◽

pp. 208-213

Author(s):

Juan González-del Castillo ◽

Clara Domínguez-Bernal ◽

María Cristina Gutiérrez-Martín ◽

María José Núñez-Orantos ◽

Francisco Javier Candel ◽

...

Keyword(s):

Emergency Department ◽

Antibiotic Therapy ◽

Hospital Stays

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Quality of febrile neutropenia management in a regional cancer center emergency department.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.104 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 104-104

Author(s):

Priyanka Kapil ◽

Katherine Enright

Keyword(s):

Emergency Department ◽

Febrile Neutropenia ◽

Antibiotic Therapy ◽

Cancer Site ◽

Cancer Center ◽

Time To Initiation ◽

The Mean ◽

The Impact ◽

Mean Time

104 Background: ASCO's current guidelines for febrile neutropenia (FN) management support antibiotic administration within one hour of presentation to the emergency department (ED). Prompt initiation of antibiotic therapy is vital to decrease the likelihood of adverse outcomes. Many studies, however, have reported significant delays in antibiotic initiation with mean wait times far exceeding ASCO's guidelines. We aimed to assess the quality of FN management at a regional cancer centre ED. Methods: Patients undergoing chemotherapy who visited the ED at the Peel Regional Cancer Center in Ontario, Canada between 04/12 - 03/13 were identified using electronic medical records. Patients were excluded if there was no record of chemotherapy delivery within 30 days prior to ED visit. ICD-10 codes and chart data were used to identify patients who had presented for either fever or infection. The primary outcome measures were three major quality of health indicators; time to assessment by a physician, Canadian Triage and Acuity Scale (CTAS) score, and time to initiation of intravenous antibiotics. Results: In total 239 records were included in the analysis. CTAS score was concordant with recommendation for FN (level 1-2) in 85% of patients and did not vary based on primary cancer site (p = 0.17). The mean time to physician assessment was 97.2 min and the mean time to initiation of IV antibiotics was 194.7 min. Overall, 14.6% of patients received their first dose of antibiotic therapy within the recommended 1 hour window. Conclusions: Our audit identified a large margin for improvement in the time to initiation of antibiotic therapy for chemotherapy patients with suspected FN. Prompt recognition and initiation of standardized treatment pathways for FN in the ED may improve the time to initiation of antibiotic therapy. In an attempt to address this gap in quality we have developed and distributed a standardized wallet-sized fever card to all patients receiving cytotoxic chemotherapy within our regional cancer program. This card contains information pertaining to the current chemotherapy treatment and recommended ED treatment protocols for FN. An evaluation of the impact of these cards is ongoing.

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