ED-based pharmacist linked to better antibiotic-guideline adherence

  • Am J Emerg Med

  • Jenny Blair, MD
  • Clinical Essentials
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Takeaway

Why this matters

  • 16% of ED patients receive antibiotic prescriptions.
  • Antimicrobial use is frequently inappropriate. 

Study design

  • Retrospective cohort study, adults with CAP or CA-IAI seen in community teaching ED (n=320).
  • Records from 2 1-year periods: soon after a hospital-implemented antimicrobial stewardship program (ASP), and 2 years later.
  • In 185 cases, emergency medicine pharmacist was present during shift.
  • Outcome: rate of guideline-concordant antimicrobial prescribing.
  • Funding: None.

Key results

  • Guideline-concordant prescription rates, with vs without pharmacist: 78% vs 61% (P=.001).
    • CAP (n=160): 95% vs 79% (P=.005);
    • CA-IAI (n=160): 62% vs 44% (P=.025).
  • Concordance rose in later vs early ASP cohorts (82.5% vs 60%; P<.001>
  • With vs without guideline-concordant prescription in ED, rate of same prescription being continued upon admission (82.5% vs 18.8%; P<.001>
  • With vs without pharmacist: no difference in hospital-onset Clostridium difficile infection, in-hospital mortality, length of stay. 

Limitations

  • Risk for selection bias.
  • Documentation of pharmacist involvement in antibiotic decision-making was not required.