Le bon usage antibiotique est essentiel dans la lutte contre l’émergence de résistances bactériennes. Peu de données sont disponibles sur l’évaluation des prescriptions antibiotiques des patients ambulatoires consultant dans les services d’urgence ainsi que sur l’impact d’un programme de bon usage (PBU). Nous avons réalisé une étude monocentrique de type avant/après comparant la qualité des prescriptions antibiotiques sur 1 année (de novembre 2012 à octobre 2013), avant implémentation d’un PBU, à celle une année après initiation de ce programme (juin 2015–mai 2016). Le programme était mené conjointement par l’infectiologue référent (IR) ainsi qu’un urgentiste. Il était constitué de : – la formation semestrielle des internes du SAU aux principes de l’antibiothérapie par l’IR ; – la possibilité de joindre l’IR par les urgentistes pour toutes questions sur la prescription des anti-infectieux aux heures ouvrables ; – la désignation d’un urgentiste correspondant pour la prescription des anti-infectieux présent au staff quotidien du service et servant de relais aux messages relatifs au bon usage ; – la vérification systématique bi-hebdomadaire par l’IR des prescriptions antibiotiques lors d’hémocultures positives Pour chacune des 2 périodes les prescriptions des patients ambulatoires (hospitalisation < 24 h) étaient évaluées à partir des dossiers médicaux conjointement par un infectiologue et un urgentiste en regard du référentiel local. Sur les périodes avant et après PBU on dénombre respectivement 34 671 et 35 925 consultations au SAU, 25 470 vs 26 208 étaient ambulatoires. L’âge moyen était 46,5 vs 43,2 ans. Au total, 760 (3,0 %) vs 580 (2,2 %) patients avaient une prescription antibiotique (p < 10−7). Nous avons identifié 455 (59,9 %) vs 258 (44,0 %) (p = 10−7) cas de non-conformité de la prescription antibiotique avec le référentiel local dont 197 (40,7 %) vs 101 (17,4 %) (p = 4,5.10−4) de prescriptions non indiquées ; 95 (19,6 %) vs 54 (9,3 %) (p > 0,05) prescriptions avec un spectre trop large ; 87 (17,97 %) vs 53 (9,1 %) (p > 0,05) de durées de traitement trop longue ; et 11 (1,4 %) vs 15 (2,5 %) (p > 0,005) de traitement inadéquats. Les prescriptions antibiotiques des patients ambulatoires au SAU sont souvent inappropriées. L’implémentation d’un PBU permet de diminuer drastiquement le nombre global de prescriptions antibiotiques ainsi que le nombre de prescriptions non indiquées. En outre cela semble réduire la durée et le spectre des antibiothérapies prescrites.

Background Antimicrobial stewardship programmes (ASPs) have been effective in optimizing antibiotic use for inpatients. However, an emergency department's fast-paced clinical setting can be challenging for a successful ASP. Aim In April 2015, an ASP was implemented in our emergency department and we aimed to determine its impact on antimicrobial use for outpatients. Methods This was a single-centre study comparing the quality of antibiotic prescriptions between a one-year period before ASP implementation (November 2012 to October 2013) and a one-year period after its implementation (June 2015 to May 2016). For each period, antimicrobial prescriptions for all adult outpatients (hospitalized for <24h) were evaluated by an infectious disease specialist and an emergency department physician to assess compliance with local prescribing guidelines. Inappropriate prescriptions were then classified. Findings Before and after ASP, 34,671 and 35,925 consultations were registered at our emergency department, of which 25,470 and 26,208 were outpatients. Antimicrobials were prescribed in 769 (3.0%) and 580 (2.2%) consultations, respectively (P < 0.0001). There were 484 (62.9%) and 271 (46.7%) (P < 0.0001) instances of non-compliance with guidelines before and after ASP implementation. Non-compliance included unnecessary antimicrobial prescriptions, 197 (25.6%) vs 101 (17.4%) (P<0.0005); inappropriate spectrum, 108 (14.0%) vs 54 (9.3%) (P=0.008); excessive treatment duration, 87 (11.3%) vs 53 (9.1%) (P>0.05); and inappropriate choices, 11 (1.4%) vs 15 (2.6%) (P>0.05). Conclusion The implementation of an ASP markedly decreased the number of unnecessary antimicrobial prescriptions, but had little impact on most other aspects of inappropriate prescribing.

Objectives. - The proper use of antibiotics is a public health priority to preserve their effectiveness. Little data is available on outpatient antibiotic prescriptions, especially in the emergency department. We aimed to assess the quality of outpatient antibiotic prescriptions in our hospital.Patients and methods. - Retrospective monocentric study of antibiotic prescriptions written to adult patients managed at the emergency department without hospitalization (November 15th, 2012-November 15th, 2013). Prescriptions were evaluated by an infectious disease specialist and an emergency physician on the basis of local recommendations compiled from national and international guidelines.Results. - A total of 760 prescriptions were reviewed. The most frequent indications were urinary tract infections (n = 263; 34.6%), cutaneous infections (n = 198; 26.05%), respiratory tract infections (n = 101; 13.28%), and ENT infections (n = 62; 8.15%). The most frequently prescribed antibiotics were fluoroquinolones (n = 314; 40.83%) and amoxicillin clavulanic acid (n = 245; 31.85%). Overall, 455 prescriptions (59.86%) did not comply with guidelines. The main reasons for inadequacy were the absence of an indication for antibiotic therapy (n = 197; 40.7%), an inadequate spectrum of activity, i.e. too broad, (n = 95; 19.62%), and excessive treatment duration (n= 87; 17.97%). Rates of inadequate prescriptions were 82.26% for ENT infections, 71.2% for cutaneous infections, 46.53% for respiratory tract infections, and 38.4% for urinary tract infections.Conclusion. - Antibiotic prescriptions written to outpatients in the emergency department are often inadequate. Enhancing prescribers' training and handing out guidelines is therefore necessary. The quality of these prescriptions should then be re-assessed. (C) 2016 Elsevier Masson SAS. All rights reserved.

The main objective of this study was to estimate the prevalence of psychological distress among adolescents seen in emergency departments, and the secondary objective was to highlight their main reasons for consulting.Cross-sectional study in three multicenter emergency departments receiving adolescents in Île-de-France conducted in 2010. All adolescents completed a questionnaire including the ADRS (Adolescent Depression Rating Scale, a screening questionnaire for depression) and a series of questions relating to somatization and risk behaviors.The study included 346 adolescents, 320 of which were fully analyzed. The ADRS score was considered normal (score < 3) for 70.6% of the sample (n = 226), 19.4% of adolescents (n = 62) had moderate depressive symptoms (3 ≤ score < 6), and 10.0% severe depressive symptoms (score ≥ 6) (n = 32). The majority of patients consulted for trauma and less than 10% for acute psychiatric problems; 17% of adolescents who came to the emergency department for a nonpsychiatric reason had an ADRS ≥ 3, i.e., with mental distress.The routine use of a self-administered questionnaire in the emergency services could identify adolescents with moderate to severe depressive symptoms.

Objectives. The main objective of this study was to estimate the prevalence of psychological distress among adolescents seen in emergency departments, and the secondary objective was to highlight their main reasons for consulting.Methods. Cross-sectional study in three multicenter emergency departments receiving adolescents in Ile-de-France conducted in 2010. All adolescents completed a questionnaire including the ADRS (Adolescent Depression Rating Scale, a screening questionnaire for depression) and a series of questions relating to somatization and risk behaviors.Results. The study included 346 adolescents, 320 of which were fully analyzed. The ADRS score was considered normal (score < 3) for 70.6% of the sample (n = 226), 19.4% of adolescents (n = 62) had moderate depressive symptoms (3 <= score < 6), and 10.0% severe depressive symptoms (score >= 6) (n = 32). The majority of patients consulted for trauma and less than 10% for acute psychiatric problems; 17% of adolescents who came to the emergency department for a nonpsychiatric reason had an ADRS >= 3, i.e., with mental distress.Conclusion. The routine use of a self-administered questionnaire in the emergency services could identify adolescents with moderate to severe depressive symptoms. (C) 2014 Elsevier Masson SAS. All rights reserved.