Antimicrobial Stewardship in the Emergency Department: Challenges, Opportunities, and a Call to Action for...

Area of Science:

• Public Health
• Infectious Diseases
• Pharmacology

Background:

• Antimicrobial resistance (AMR) is a significant national public health concern.
• Misuse of antimicrobials for common infections like upper respiratory infections, urinary tract infections, and cellulitis drives resistance to critical drugs.
• The emergency department (ED) is a key setting for encountering these infections and influencing antimicrobial use patterns.

Purpose of the Study:

• To review successful interventions that have reduced inappropriate antimicrobial use in the ED.
• To propose novel, yet unvalidated, strategies for antimicrobial stewardship in emergency medicine.
• To emphasize the critical role of pharmacists in antimicrobial stewardship programs within ED settings.

Main Methods:

• Literature review of successful antimicrobial stewardship interventions in the ED.
• Identification of challenges in implementing stewardship programs in the ED (e.g., diagnostic uncertainty, high patient turnover).
• Proposal of new, evidence-based interventions for future research and validation.

Main Results:

• Successful interventions have been identified that curb inappropriate antimicrobial use in the ED.
• Existing challenges to ED antimicrobial stewardship include diagnostic uncertainty and operational demands.
• Further research is needed to validate proposed interventions and optimize antimicrobial prescribing.

Conclusions:

• The ED is pivotal in combating antimicrobial resistance through effective stewardship.
• Overcoming implementation challenges is crucial for successful antimicrobial stewardship in emergency medicine.
• Pharmacists are essential in driving research and implementation of antimicrobial stewardship initiatives to mitigate AMR.