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Table 3 Implementation of antimicrobial stewardship in participating emergency departments stratified according to hospital size, level of care and organizational structure

From: Antimicrobial resistance control in the emergency department: a need for concrete improvement

 

All

(n = 66)

Hospital sizea

Level of care according to the G-BA categoriesb

Organizational structure of EDc

Attribution of ED

ED physicians’ team structure

< 400 Beds

(n = 19)

≥ 400 beds

(n = 47)

1

(n = 12)

2

(n = 26)

3

(n = 28)

Attributed to CMO

(n = 51)

Attributed to clinical department

(n = 11)

No data

(n = 4)

Mainly core team

(n = 23)

Mainly physicians seconded to the ED

(n = 30)

No data

(n = 13)

n (%), if not otherwise specified

AMS expert(s) at hospital level

49 (74)

14 (74)

35 (75)

7 (58)

21 (81)

21 (75)

41 (80)

6 (55)

2 (50)

16 (70)

22 (73)

11 (85)

 Collaboration with ED to optimize antibiotic therapy

33 (67)

11 (79)

22 (63)

5 (71)

15 (71)

13 (62)

30 (73)

2 (33)

1 (50)

11 (69)

14 (64)

8 (73)

ED physician with AMS training and responsibility (AMS link physician)

10 (15)

1 (5)

9 (19)

1 (8)

2 (8)

7 (25)

9 (18)

1 (9)

0 (0)

5 (22)

4 (13)

1 (8)

Availability of resistance datad

 Resistance data at regional level

9 (14)

4 (21)

5 (11)

0 (0)

5 (19)

4 (14)

8 (16)

0 (0)

1 (25)

3 (13)

4 (13)

2 (15)

 Resistance data at hospital level

49 (74)

14 (74)

35 (75)

6 (50)

21 (81)

22 (79)

41 (80)

6 (55)

2 (50)

15 (65)

23 (77)

11 (85)

 Resistance data at ED levele

10 (15)

2 (11)

8 (17)

0 (0)

3 (12)

7 (25)

7 (14)

2 (18)

1 (25)

6 (26)

1 (3)

3 (23)

Surveillance of antimicrobial usef,g

42 (64)

8 (42)

34 (72)

3 (25)

18 (69)

21 (75)

34 (67)

7 (64)

1 (25)

15 (65)

19 (63)

8 (62)

Antimicrobial restriction policy in the EDd

 Authorisation by ED head physician or deputy

20 (30)

5 (26)

15 (32)

3 25)

7 (27)

10 (36)

18 (35)

1 (9)

1 (25)

9 (39)

8 (27)

3 (23)

 Authorisation by local ED physician with AMS training and responsibility

1 (2)

0 (0)

1 (2)

0 (0)

1 (4)

0 (0)

1 (2)

0 (0)

0 (0)

1 (4)

0 (0)

0 (0)

 Authorisation by hospital AMS expert(s)

4 (6)

2 (11)

2 (4)

0 0)

2 (8)

2 (7)

4 (8)

0 (0)

0 (0)

2 (9)

1 (3)

1 (8)

 Approval via specific prescriptionf

15 (23)

2 (11)

13 (28)

0 (0)

5 (19)

10 (36)

12 (24)

2 (18)

1 (25)

7 (30)

6 (20)

2 (15)

 Restricted antimicrobial is inhibited at the hospital levele

15 (23)

3 (16)

12 (26)

1 (8)

7 (27)

7 (25)

13 (26)

2 (18)

0 (0)

5 (22)

4 (13)

6 (46)

AMS training offered in the ED

 Regularly at least once a year

13 (20)

2 (11)

11 (23)

2 (17)

3 (12)

8 (29)

11 (22)

1 (9)

1 (25)

7 (30)

3 (10)

3 (23)

 Irregularly

23 (35)

5 (26)

18 (38)

2 (17)

8 (31)

13 (46)

18 (35)

4 (36)

1 (25)

6 (26)

13 (43)

4 (31)

Diagnostic Stewardship training offered in the EDe,f

28 (42)

6 (32)

22 (47)

2 (17)

10 (39)

16 (57)

29 (57)

5 (46)

2 (50)

12 (52)

11 (37)

5 (39)

MDRO Screening in patients to be admitted to hospitald

 MRSA in general

12 (18)

2 (11)

10 (21)

1 (8)

6 (23)

5 (18)

9 (18)

3 (27)

0 (0)

2 (9)

7 (23)

3 (23)

 MRSA according to risk factorsg

45 (68)

17 (90

28 (60)

10 (83)

19 (73)

16 (57)

35 (69)

7 (64)

3 (75)

15 (65)

22 (73)

8 (62)

 VRE in general

2 (3)

0 (0)

2 (4)

0 (0)

1 (4)

1 (4)

2 (4)

0 (0)

0 (0)

1 (4)

1 (3)

0 (0)

 VRE according to risk factors

30 (46)

11 (58)

19 (40)

5 (42)

14 (54)

11 (39)

23 (45)

6 (55)

1 (25)

9 (39)

14 (47)

7 (54)

 MRGN in general

3 (5)

0 (0)

3 (6)

0 (0)

1 (4)

2 (7)

2 (4)

1 (9)

0 (0)

1 (4)

2 (7)

0 (0)

 MRGN according to risk factors

43 (65)

14 (74)

29 (62)

7 (58)

20 (77)

16 (57)

33 (65)

9 (82)

1 (25)

13 (57)

21 (70)

9 (69)

Numbers of blood culturesh /100 patients; n of EDs providing data; median, (IQR)

29;

3.7 (2.4–7.9)

8;

4 (3.1–15.8)

21;

3.7 (1.9–7.3)

1;

1.2 (1.2–1.2)

15;

3.7 (3–8.1)

13;

6 (2.4–7.3)

23;

4.9 (2.8–8.1)

5;

3.1 (2.4–7.9)

1;

1.9 (1.9–1.9)

7;

2.8 (1.8–6.8)

16;

4.3 (2.7–8)

6;

8 (3.1–12)

  1. G-BA, German Federal Joint Committee; ED, emergency department; CMO, Chief Medical Director; AMS, antimicrobial stewardship; MDRO, multidrug-resistant organisms; MRSA, methicillin-resistant Staphylococcus aureus; VRE, Vancomycin resistant Enterococci; MRGN, multidrug-resistant gram-negative bacteria
  2. aHospital size (number of acute care beds); < 400 beds (n = 19), ≥ 400 beds (n = 47)
  3. bLevel of emergency care according to the G-BA categories; Level 1 (n = 12), level 2 (n = 26), level 3 (n = 28) [18]
  4. cOrganizational structure of ED: Allocation of ED; Allocated to CMO (n = 51), allocated to clinical department (n = 11), no data (n = 4)
  5. Medical team structure; mainly core team (n = 23), mainly physicians seconded to the ED (n = 30), no data (n = 13)
  6. dMultiple answers possible
  7. eDifferences between medical team structures: P < 0.05 (chi-square test)
  8. fDifferences between level of emergency care according to the G-BA level categories: P < 0.05 (chi-square test)
  9. gDifferences between size of the hospital: P < 0.05 (chi-square test)
  10. hBlood cultures were defined as a pair of one aerobic and one anaerobic bottle. In case of separate aerobe and anaerobe bottles, the number of aerobic bottles was selected
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Antimicrobial Resistance & Infection Control

ISSN: 2047-2994

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