{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T18:21:00Z","timestamp":1767982860952,"version":"3.49.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T00:00:00Z","timestamp":1710201600000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Children's Health Ireland Foundation"},{"name":"CHI Research & Innovation Office"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To determine the percentage of patients across Ireland who are discharged from the Emergency Department (ED) with an antimicrobial prescription, the indication, classification of infections, and guideline compliance. To identify potential areas for antimicrobial stewardship (AMS) interventions in the ED.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients and methods<\/jats:title>\n                  <jats:p>A multicentre, prospective cohort analysis study in EDs across eight hospitals in Ireland. At each site, patients aged 1\u2005month and older who presented to the ED and were discharged directly from the ED were included. A random selection of records of patients discharged from the ED were reviewed until a minimum of 30 records with an infection diagnosis resulting in an antibiotic prescription were obtained per hospital. The number of patient discharges with no antibiotic prescriptions were included to calculate the denominator. The indication, infection classification and guideline compliance data were collected on the 30 prescriptions in the participating hospitals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 2619 patient records were reviewed. Of these, 249 (9.5%) patients were discharged with antimicrobial prescriptions from the ED. Most (158; 63%) were classified as probable bacterial infection, 21 (8%) as probable viral, and 18 (7%) had no documented evidence of infection. Three indications accounted for 73% of antimicrobial prescriptions: skin\/soft tissue infection; ear, nose and throat infection; and urinary tract infection. Overall guideline compliance was 64%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Several areas for AMS interventions to optimize antimicrobial prescribing in the ED were identified, including targeted local and national guideline reviews, delayed prescribing, improved point-of-care testing and prescriber and patient education.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jacamr\/dlae038","type":"journal-article","created":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T09:43:39Z","timestamp":1710236619000},"source":"Crossref","is-referenced-by-count":1,"title":["Where to start? The Irish Emergency Department Antimicrobial Discharge (EDAD) study: a multicentre, prospective cohort analysis"],"prefix":"10.1093","volume":"6","author":[{"given":"Aisling","family":"Rafferty","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Children\u2019s Health Ireland at Temple Street , Dublin , Ireland"},{"name":"School of Pharmacy, Institute of Clinical Sciences, University of Birmingham , Birmingham , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alida Fe","family":"Talento","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Children\u2019s Health Ireland at Temple Street , Dublin , Ireland"},{"name":"Department of Microbiology, Royal College of Surgeons , Dublin , Ireland"},{"name":"Department of Microbiology, Trinity College Dublin , Dublin , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9797-3797","authenticated-orcid":false,"given":"Richard","family":"Drew","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Children\u2019s Health Ireland at Temple Street , Dublin , Ireland"},{"name":"Clinical Innovation Unit, Rotunda Hospital , Dublin , Ireland"},{"name":"Irish Meningitis and Sepsis Reference Laboratory , Dublin , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Fitzpatrick","sequence":"additional","affiliation":[{"name":"Emergency Department, Children\u2019s Health Ireland at Temple Street , Dublin , Ireland"},{"name":"Department of General Paediatrics, Royal College of Surgeons , Dublin , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kara","family":"Tedford","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Children\u2019s Health Ireland at Crumlin , Dublin , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1775-8347","authenticated-orcid":false,"given":"Michael","family":"Barrett","sequence":"additional","affiliation":[{"name":"Emergency Department, Children\u2019s Health Ireland at Crumlin , Dublin , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Husnain","family":"Mahomed","sequence":"additional","affiliation":[{"name":"Emergency Department, Children\u2019s Health Ireland at Crumlin , Dublin , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabrina","family":"O\u2019Regan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Portiuncula University Hospital , Galway , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louise","family":"Delany","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, National Maternity Hospital , Dublin , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00edle","family":"O\u2019Connor","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University Hospital Kerry , Kerry , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agne","family":"Buseckyte","sequence":"additional","affiliation":[{"name":"Emergency Department, University Hospital Kerry , Kerry , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrei","family":"Brovchin","sequence":"additional","affiliation":[{"name":"Emergency Department, University Hospital Kerry , Kerry , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elhaytham","family":"Hassan","sequence":"additional","affiliation":[{"name":"Emergency Department, University Hospital Kerry , Kerry , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Marzec","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Our Lady\u2019s Hospital Navan , Meath , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donna","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Cavan General Hospital , Cavan , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clare","family":"Greene","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Midland Regional Hospital , Tullamore, Offaly , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Marriott","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Institute of Clinical Sciences, University of Birmingham , Birmingham , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Cunney","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Children\u2019s Health Ireland at Temple Street , Dublin , Ireland"},{"name":"Department of Microbiology, Royal College of Surgeons , Dublin , Ireland"},{"name":"Irish Meningitis and Sepsis Reference Laboratory , Dublin , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,3,12]]},"reference":[{"key":"2024042911454541900_dlae038-B1","author":"WHO"},{"key":"2024042911454541900_dlae038-B2","author":"O\u2019Neill"},{"key":"2024042911454541900_dlae038-B3","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1197\/j.aem.2005.11.075","article-title":"Antibiotic misuse in the emergency department","volume":"13","author":"Karras","year":"2006","journal-title":"Acad Emerg Med"},{"key":"2024042911454541900_dlae038-B4","doi-asserted-by":"crossref","first-page":"2096","DOI":"10.1136\/bmj.c2096","article-title":"Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis","volume":"340","author":"Costelloe","year":"2010","journal-title":"Br Med J"},{"key":"2024042911454541900_dlae038-B5","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1471-2334-14-13","article-title":"A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance","volume":"14","author":"Bell","year":"2014","journal-title":"BMC Infect Dis"},{"key":"2024042911454541900_dlae038-B6","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1001\/jamainternmed.2017.1938","article-title":"Association of adverse events with antibiotic use in hospitalized patients","volume":"177","author":"Tamma","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2024042911454541900_dlae038-B7","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1177\/1060028017709820","article-title":"A systematic review of antimicrobial stewardship interventions in the emergency department","volume":"51","author":"Losier","year":"2017","journal-title":"Ann Pharmacother"},{"key":"2024042911454541900_dlae038-B8","volume-title":"Guidelines for Antimicrobial Stewardship in Hospitals in Ireland","author":"SARI Hospital Antimicrobial Stewardship Working Group","year":"2009"},{"key":"2024042911454541900_dlae038-B9","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":"2024042911454541900_dlae038-B10","doi-asserted-by":"crossref","first-page":"369","DOI":"10.4103\/JPBS.JPBS_311_19","article-title":"A narrative review of antimicrobial stewardship interventions within in-patient settings and resultant patient outcomes","volume":"12","author":"Shirazi","year":"2020","journal-title":"J Pharm Bioallied Sci"},{"key":"2024042911454541900_dlae038-B11","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1093\/jac\/dky447","article-title":"Appropriateness of antibiotic prescribing in the emergency department","volume":"74","author":"Denny","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"2024042911454541900_dlae038-B12","first-page":"1","article-title":"National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary","volume":"26","author":"Niska","year":"2010","journal-title":"Natl Health Stat Report"},{"key":"2024042911454541900_dlae038-B13","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1017\/ice.2017.3","article-title":"Current state of antimicrobial stewardship in children\u2019s hospital emergency departments","volume":"38","author":"Mistry","year":"2017","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2024042911454541900_dlae038-B14","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1093\/cid\/ciw217","article-title":"Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America","volume":"62","author":"Barlam","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2024042911454541900_dlae038-B15","author":"Health Service Executive"},{"key":"2024042911454541900_dlae038-B16","author":"Royal College of Physicians of Ireland, Irish Association of Directors of Nursing and Midwifery, Therapy Professions Committee, Quality Clinical Care Directorate, Health Service Executive"},{"key":"2024042911454541900_dlae038-B17","author":"Raosoft Inc"},{"key":"2024042911454541900_dlae038-B18","doi-asserted-by":"crossref","first-page":"688272","DOI":"10.3389\/fped.2021.688272","article-title":"A novel framework for phenotyping children with suspected or confirmed infection for future biomarker studies","volume":"9","author":"Nijman","year":"2021","journal-title":"Front Pediatr"},{"key":"2024042911454541900_dlae038-B19","author":"Health Service Executive"},{"key":"2024042911454541900_dlae038-B20","author":"NICE"},{"key":"2024042911454541900_dlae038-B21","doi-asserted-by":"crossref","first-page":"308","DOI":"10.5858\/arpa.2020-0495-RA","article-title":"Point-of-care testing for the emergency department patient quantity and quality of the available evidence","volume":"145","author":"Alter","year":"2021","journal-title":"Arch Pathol Lab Med"},{"key":"2024042911454541900_dlae038-B22","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1111\/jpc.13092","article-title":"Utility of early influenza diagnosis through point-of-care testing in children presenting to an emergency department: flu point-of-care testing in paediatric emergency","volume":"52","author":"Li-Kim-Moy","year":"2016","journal-title":"J Paediatr Child Health"},{"key":"2024042911454541900_dlae038-B23","author":"Borek"},{"key":"2024042911454541900_dlae038-B24","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1080\/13814788.2020.1784137","article-title":"Improving the quality of antibiotic prescribing through an educational intervention delivered through the out-of-hours general practice service in Ireland","volume":"26","author":"O\u2019Connor","year":"2020","journal-title":"Eur J Gen Pract"},{"key":"2024042911454541900_dlae038-B25","author":"Health Information Quality Authority"},{"key":"2024042911454541900_dlae038-B26","doi-asserted-by":"crossref","first-page":"8190","DOI":"10.3390\/su12198190","article-title":"Outcomes of establishing an urgent care centre in the same location as an emergency department","volume":"12","author":"Raidla","year":"2020","journal-title":"Sustainability"}],"container-title":["JAC-Antimicrobial Resistance"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jacamr\/article-pdf\/6\/2\/dlae038\/57342013\/dlae038.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jacamr\/article-pdf\/6\/2\/dlae038\/57342013\/dlae038.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T12:04:29Z","timestamp":1714392269000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jacamr\/article\/doi\/10.1093\/jacamr\/dlae038\/7626145"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,5]]},"references-count":26,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,3,5]]}},"URL":"https:\/\/doi.org\/10.1093\/jacamr\/dlae038","relation":{},"ISSN":["2632-1823"],"issn-type":[{"value":"2632-1823","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,4]]},"published":{"date-parts":[[2024,3,5]]},"article-number":"dlae038"}}