• Fernando Oltra Hostalet, María Núñez-Núñez, María Del Mar Portillo Cano, Carmen Navarro Bustos, Jesús Rodríguez-Baño, and Pilar Retamar Gentil.
• Unidad de Gestión Clínica de Urgencias, Hospital Universitario Virgen Macarena, Sevilla, España.
• Emergencias. 2018 Oct 1; 30 (5): 297-302.

ObjectivesTo describe modifiable factors related to inappropriate antimicrobial treatment in the observation area of an emergency department to explore practices that can be targeted for change through a program to improve emergency use of antimicrobial agents, the PROA program in its spanish observations.Material And MethodsCross-sectional serial point-prevalence study of all antimicrobial prescriptions for patients under observation in the department in February and March 2015.The main outcome measure was the frequency of antimicrobial treatment that was inappropriate according the center's guidelines. Two evaluators assessed appropriateness.ResultsWe analyzed 406 antimicrobial treatments. The main clinical syndromes were pneumonia (24%), urinary infections (22%), and nonpneumonia lower respiratory infections (22%). We found that 51.5% of the antimicrobial treatments were inappropriate. Factors associated with inappropriate prescriptions were a failure to analyze microbiologic samples before treating (61%), failure to specify the focus of infection in the case records (73%), and failure to meet the definition of sepsis (58%).ConclusionFewer than half the antimicrobial treatments were appropriate as prescribed. Signs of serious infection, specification of the focus of infection in the patient's records, and the analysis of biologic samples were independent predictors of quality care (appropriate antimicrobial prescription). These factors can be targeted for training in the development of a specific emergency department program to improve this aspect of care.

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