Limited value of sputum culture to guide antibiotic treatment in a Danish emergency department.

INTRODUCTION Antibiotics resistance is increasing worldwide. The Region of Southern Denmark developed an antibiotic stewardship to reduce the use of broad-spectrum antibiotics in hospitals including microbiological diagnostics of sputum samples. The aim of this study was to evaluate the implementation of the stewardship in the emergency department (ED) concerning management of pulmonary infections. The objectives were: 1) to investigate whether the empirical therapy was prescribed correctly, 2) to identify the quality and results of pre-antibiotic sputum collection and 3) to investigate whether the antibiotic treatment was revised based on the microbiological results. METHODS This was a quality assessment study. Patient files from patients discharged with either pneumonia or acute exacerbation of chronic pulmonary disease were reviewed, and written feedback was provided to the doctors, focusing on the regional guideline. RESULTS Among the 257 medical records audited, the guideline was followed in 89% of the cases. Pre-antibiotic sputum samples were collected from 47% of the patients and 79% of these had sufficient quality for cultivation. None of the empirical antibiotic treatments were revised based on the microbiological results but some were revised based on other clinical parameters. CONCLUSIONS Sputum samples had no clinical value for adjustment of the antibiotic treatment. Improvements of sputum sample collection and faster microbiological diagnostics are needed for sputum analysis to have any impact on the antibiotic treatment of patients with a pulmonary infection in the ED. FUNDING none. TRIAL REGISTRATION not relevant.