Appropriateness of antibiotic selection at emergency department discharge and risk of 30-day adverse events in patients with acute exacerbation of COPD
Abstract
Objective To describe antibiotic prescribing patterns in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) managed in emergency departments (EDs), assess the appropriateness of antibiotic selection according to Spanish guideline recommendations, and analyse its association with 30-day clinical outcomes. Methods Analysis derived from the multicentre retrospective EPOC-URG CAM registry (19 EDs in the Community of Madrid, 2022–2024), which included episodes of AECOPD. Antibiotic appropriateness was defined a priori according to national guideline recommendations. The primary outcome was the occurrence of an adverse event within 30 days, defined as recurrence of the exacerbation, ED revisit, hospitalisation, or death. The primary analysis was restricted to patients discharged directly from the ED with oral antibiotic treatment. Relative risks (RRs) were estimated using Poisson regression. Results A total of 4,136 episodes were analysed (mean age 74.5 ± 11.1 years; 68.3% male; 45.8% with a Charlson index ≥3). In the ED, 2,626 patients (63.5%) received antibiotics, with levofloxacin being the most frequently prescribed agent both in the ED (32.6%) and at discharge (39.3%). Patients’ clinical profiles were very similar regardless of the antibiotic class prescribed at discharge. Of the 1,736 (42%) patients discharged directly from the ED, 987 (56.9%) received antibiotic treatment, and the prescription was considered inappropriate in 158 (16.0%). The incidence of…
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