{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T12:47:09Z","timestamp":1788526029980,"version":"build-2803163510"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"21","license":[{"start":{"date-parts":[[2019,10,15]],"date-time":"2019-10-15T00:00:00Z","timestamp":1571097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>To assess antibiotic selection, administration, and prescribing practices in emergency departments across a large hospital system using evidence-based practices and susceptibility patterns.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective data review was conducted using health system\u2013level electronic data compiled from 145 emergency departments (EDs) across the United States. Data were examined for national generalizability, most common diagnoses of infectious origin seen in nonadmitted patients in the ED, most commonly administered antibiotics in the ED, and geographically defined areas\u2019 unique patterns of antibiotic resistance and susceptibility.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>More than 627,000 unique patient encounters and 780,000 antibiotic administrations were assessed for trends in patient demographics, antibiotics administered for a diagnosis of infectious origin, and corresponding susceptibility patterns. Results indicated that practices in the EDs of this health system aligned with evidence-based practices for streptococcal pharyngitis, otitis media, cellulitis, and uncomplicated urinary tract infections.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>These results provide a representative sample of the current state of practices within many EDs across the United States for nonadmitted patients. A similar data reconstruction can be completed by other health systems to assess their prescribing practices in the ED to improve and elevate care for patients visiting the emergency room and treated as outpatients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajhp\/zxz193","type":"journal-article","created":{"date-parts":[[2019,10,15]],"date-time":"2019-10-15T05:30:52Z","timestamp":1571117452000},"page":"1753-1761","source":"Crossref","is-referenced-by-count":7,"title":["Analysis of antibiotic use in a large network of emergency departments"],"prefix":"10.1093","volume":"76","author":[{"given":"Fredrick","family":"O\u2019Neal","sequence":"first","affiliation":[{"name":"Clinical Services Group, HCA Healthcare Nashville, and University of Tennessee College of Pharmacy, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Kramer","sequence":"additional","affiliation":[{"name":"Clinical Services Group, HCA Healthcare Nashville, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandelin","family":"Cooper","sequence":"additional","affiliation":[{"name":"Clinical Services Group, HCA Healthcare Nashville, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Septimus","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanya","family":"Sharma","sequence":"additional","affiliation":[{"name":"Clinical Services Group, HCA Healthcare Nashville, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L Hayley","family":"Burgess","sequence":"additional","affiliation":[{"name":"Clinical Services Group, HCA Healthcare Nashville, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,10,15]]},"reference":[{"key":"2019101505090711700_CIT0001","first-page":"277","article-title":"The antibiotic resistance crisis: part 1: causes and threats","volume":"40","author":"Ventola","year":"2015","journal-title":"P T."},{"key":"2019101505090711700_CIT0002","first-page":"344","article-title":"The antibiotic resistance crisis: part 2: management strategies and new agents","volume":"40","author":"Ventola","year":"2015","journal-title":"P T."},{"key":"2019101505090711700_CIT0003","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1038\/ja.2017.30","article-title":"The antibiotic resistance crisis, with a focus on the united states","volume":"70","author":"Martens","year":"2017","journal-title":"J Antibiot."},{"key":"2019101505090711700_CIT0004","doi-asserted-by":"crossref","first-page":"E222","DOI":"10.1503\/cmaj.1095383","article-title":"Antibiotic overprescribing a growing problem","volume":"189","author":"Webster","year":"2017","journal-title":"CMAJ."},{"key":"2019101505090711700_CIT0005","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.annemergmed.2012.09.002","article-title":"A call to action for antimicrobial stewardship in the emergency department: approaches and strategies","volume":"62","author":"May","year":"2013","journal-title":"Ann Emerg Med."},{"key":"2019101505090711700_CIT0006","first-page":"1","article-title":"National hospital ambulatory medical care survey: 2007 emergency department summary","author":"Niska","year":"2010","journal-title":"Natl Health Stat Report."},{"key":"2019101505090711700_CIT0007","unstructured":"World Health Organization Antibiotic Resistance. https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/antimicrobial-resistance. (accessed 2017 Sep 13)."},{"key":"2019101505090711700_CIT0008","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.annemergmed.2007.03.026","article-title":"Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction","volume":"50","author":"Ong","year":"2007","journal-title":"Ann Emerg Med."},{"key":"2019101505090711700_CIT0009","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1086\/591126","article-title":"Emergency department visits for antibiotic-associated adverse events","volume":"47","author":"Shehab","year":"2008","journal-title":"Clin Infect Dis."},{"key":"2019101505090711700_CIT0010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1553-2712.2008.00295.x","article-title":"The effect of emergency department crowding on clinically oriented outcomes","volume":"16","author":"Bernstein","year":"2009","journal-title":"Acad Emerg Med."},{"key":"2019101505090711700_CIT0011","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1111\/j.1553-2712.2009.00522.x","article-title":"Antibiotic prescriptions are associated with increased patient satisfaction with emergency department visits for acute respiratory tract infections","volume":"16","author":"Stearns","year":"2009","journal-title":"Acad Emerg Med."},{"key":"2019101505090711700_CIT0012","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1136\/emermed-2014-204220","article-title":"Antimicrobial stewardship in emergency departments: a neglected topic","volume":"32","author":"Pulcini","year":"2015","journal-title":"Emerg Med J."},{"key":"2019101505090711700_CIT0013","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1111\/acem.12729","article-title":"Antimicrobial susceptibility of escherichia coli in uncomplicated cystitis in the emergency department: is the hospital antibiogram an effective treatment guide?","volume":"22","author":"Smith","year":"2015","journal-title":"Acad Emerg Med."},{"key":"2019101505090711700_CIT0014","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.diagmicrobio.2013.01.026","article-title":"Comparison of antibiograms developed for inpatients and primary care outpatients","volume":"76","author":"McGregor","year":"2013","journal-title":"Diagn Microbiol Infect Dis."},{"key":"2019101505090711700_CIT0015","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.2146\/ajhp130079","article-title":"Comparison of bacteria isolated from emergency department patients versus hospitalized patients","volume":"70","author":"Draper","year":"2013","journal-title":"Am J Health-Syst Pharm."},{"key":"2019101505090711700_CIT0016","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1056\/NEJMcp061493","article-title":"Clinical practice. Acute bronchitis","volume":"355","author":"Wenzel","year":"2006","journal-title":"N Engl J Med."},{"key":"2019101505090711700_CIT0017","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1542\/peds.2014-1827","article-title":"Medication-related emergency department visits in pediatrics: a prospective observational study","volume":"135","author":"Zed","year":"2015","journal-title":"Pediatrics."},{"key":"2019101505090711700_CIT0018","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1001\/jama.2010.1553","article-title":"Long-term cognitive impairment and functional disability among survivors of severe sepsis","volume":"304","author":"Iwashyna","year":"2010","journal-title":"JAMA."},{"key":"2019101505090711700_CIT0019","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.ijid.2014.03.860","article-title":"Do we have organized opat services in Japan? Overuse of ceftriaxone for outpatients","volume":"21","author":"Hase","year":"2014","journal-title":"Intern J Infect Dis."},{"issue":"7","key":"2019101505090711700_CIT0020","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.1093\/cid\/cir531","article-title":"The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America","volume":"53","author":"Bradley","year":"2011","journal-title":"Clin Infect Dis."},{"issue":"8","key":"2019101505090711700_CIT0021","doi-asserted-by":"crossref","first-page":"e72","DOI":"10.1093\/cid\/cis370","article-title":"IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults","volume":"54","author":"Chow","year":"2012","journal-title":"Clin Infect Dis."},{"issue":"5","key":"2019101505090711700_CIT0022","doi-asserted-by":"crossref","first-page":"e103","DOI":"10.1093\/cid\/ciq257","article-title":"International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society For Microbiology and Infectious Diseases","volume":"52","author":"Gupta","year":"2011","journal-title":"Clin Infect Dis."},{"key":"2019101505090711700_CIT0023","first-page":"435","article-title":"Otitis media: diagnosis and treatment","volume":"88","author":"Harmes","year":"2013","journal-title":"Am Fam Physician."},{"key":"2019101505090711700_CIT0024","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1086\/511159","article-title":"Infectious Diseases Society of America\/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults","volume":"44","author":"Mandell","year":"2007","journal-title":"Clin Infect Dis."},{"key":"2019101505090711700_CIT0025","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1093\/cid\/cis847","article-title":"Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America","volume":"55","author":"Shulman","year":"2012","journal-title":"Clin Infect Dis."},{"issue":"2","key":"2019101505090711700_CIT0026","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1093\/cid\/ciu296","article-title":"Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin Infect Dis."},{"key":"2019101505090711700_CIT0027","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1177\/003335490712200413","article-title":"Medicaid\/state children\u2019s health insurance program patients and infectious diseases treated in emergency departments: U.S., 2003","volume":"122","author":"Adekoya","year":"2007","journal-title":"Public Health Rep."},{"key":"2019101505090711700_CIT0028","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/clinids\/23.1.1","article-title":"Infectious disease issues in the emergency department","volume":"23","author":"Talan","year":"1996","journal-title":"Clin Infect Dis."},{"key":"2019101505090711700_CIT0029","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1177\/8755122517720293","article-title":"Appropriate use of ceftriaxone in the emergency department of a veteran\u2019s health care system","volume":"33","author":"Durham","year":"2017","journal-title":"J Pharm Technol."},{"key":"2019101505090711700_CIT0030","volume-title":"Specifications manual for national hospital inpatient quality measures. The joint commission"},{"key":"2019101505090711700_CIT0031","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1086\/656431","article-title":"Skin and soft-tissue infections requiring hospitalization at an academic medical center: opportunities for antimicrobial stewardship","volume":"51","author":"Jenkins","year":"2010","journal-title":"Clin Infect Dis."}],"container-title":["American Journal of Health-System Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ajhp\/article-pdf\/76\/21\/1753\/30147545\/zxz193.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ajhp\/article-pdf\/76\/21\/1753\/30147545\/zxz193.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,10,15]],"date-time":"2019-10-15T05:31:13Z","timestamp":1571117473000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajhp\/article\/76\/21\/1753\/5587320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,15]]},"references-count":31,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2019,10,15]]},"published-print":{"date-parts":[[2019,10,15]]}},"URL":"https:\/\/doi.org\/10.1093\/ajhp\/zxz193","relation":{},"ISSN":["1079-2082","1535-2900"],"issn-type":[{"value":"1079-2082","type":"print"},{"value":"1535-2900","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,11,1]]},"published":{"date-parts":[[2019,10,15]]}}}