Pharmacist-driven antimicrobial optimization in the emergency department.

Area of Science:

• Infectious Diseases
• Clinical Pharmacy
• Antimicrobial Stewardship

Background:

• Antimicrobial resistance necessitates optimized prescribing practices.
• Emergency departments (EDs) are critical points for antimicrobial initiation.
• The role of pharmacists in antimicrobial stewardship requires further evaluation.

Purpose of the Study:

• To assess the value of a pharmacist-driven antimicrobial optimization service in a non-trauma ED.
• To compare pharmacist interventions with nursing management in positive culture follow-up.
• To analyze local antimicrobial resistance patterns to inform empiric prescribing.

Main Methods:

• Retrospective electronic chart review of ED patients with positive cultures.
• Comparison of two three-month periods: nursing management (Period 1) vs. ED clinical pharmacists (Period 2).
• Primary outcome: number of clinical interventions for indicated positive cultures. Secondary outcome: analysis of resistance patterns.

Main Results:

• Pharmacists intervened in 80% of indicated positive cultures, a 30% absolute increase compared to nursing (50%).
• This resulted in a statistically significant increase in interventions for inappropriate therapy (p=0.01).
• A 38% fluoroquinolone resistance rate was observed in E. coli, the most common urinary isolate.

Conclusions:

• Pharmacist-driven antimicrobial stewardship significantly improves intervention rates for inappropriate therapy.
• ED pharmacists are valuable assets in antimicrobial stewardship programs.
• High fluoroquinolone resistance necessitates alternative empiric therapies for urinary tract infections, with nitrofurantoin as a viable option.