Program Schedule

Building Bridges: Improving Antibiotic Prescribing in the Emergency Department

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • IDWeek 2014 ED-ID Poster Final.pdf (289.3 kB)
  • Background: Emergency room utilization in the US has increased over the last decade. Little is known about antibiotic utilization and its appropriateness in the Emergency Department (ED). Published data indicate that over 50% of patients presenting with viral upper respiratory tract infections receive inappropriate antibiotics during an ED visit. Thus, opportunities exist to improve prescribing.

    Methods: We implemented an antibiotic stewardship (ASP) and infectious diseases (ID) management pilot program, designed in collaboration with the ED at the Einstein Campus of Montefiore Medical Center (a 424 bed non-profit teaching facility with over 72,000 ED visits a year and 16,000 admissions), the University Hospital of Albert Einstein College of Medicine in Bronx, NY. For 17 consecutive weeks an ID physician was notified about patients presenting with infectious conditions by ED providers or ASP staff (during antibiotic auditing and approval calls). An ID physician formally evaluated the patient and offered recommendations for antibiotic selection, dosing, duration, additional testing, and when appropriate, outpatient management. Patients who were hospitalized were offered follow up with an ID specialist.

    Results: During the intervention period, 230 patients were evaluated. Of those patients, 138 (60%) were initially prescribed ‘inappropriate’ antimicrobial regimens. Outpatient management with discharge from the ED was recommended in 28 (12%) patients, and 28 (12%) were recommended to stop antimicrobial therapy completely. Acceptability of ASP/ID consultation was high, with 92% of ED physicians prescribing the recommended antibiotic regimen.

    TABLE 1

    N (%)

    Prescribing details

    Number of Consults



    Antibiotics prescribing inappropriate

    138 (60)

    Reasons, N (%):

    No antibiotics needed: 28 (12)

    Coverage too broad: 37 (16)

    Coverage too narrow: 27 (12)

    Able to switch to oral: 17 (7)

    Other (e.g., incorrect drug due to allergy or prior cultures, incorrect dosing) 29 (13)

    Conclusion: Our pilot data suggests that a collaborative approach with early ASP and ID consultation in the ED is a feasible and acceptable model that can improve initial antibiotic prescribing, reduce unnecessary antibiotic use, improve patient safety, avert unnecessary hospital admissions and build relationships with ED staff.

    Theresa Madaline, MD1, Marta Feldmesser, MD, FIDSA1, Philip Chung, PharmD, MS2, Johanna Daily, MD, MS1, Mahalia Desruisseaux, MD1, Sarah Hochman, MD1, Marla Keller, MD1, Ira Leviton, MD1, Kerry Murphy, MD3, Anjali Sharma, MD3, Scott Pearlman, MD4, Nadine Katz, MD5, Deborah White, MD4, Liise-Anne Pirofski, MD, FIDSA1 and Belinda Ostrowsky, MD, MPH1, (1)Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, (2)Pharmacy, Montefiore Medical Center, Bronx, NY, (3)Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, (4)Department of Emergency Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, (5)Department of Clinical Ob-Gyn and Women's Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY


    T. Madaline, None

    M. Feldmesser, None

    P. Chung, None

    J. Daily, None

    M. Desruisseaux, None

    S. Hochman, None

    M. Keller, None

    I. Leviton, None

    K. Murphy, None

    A. Sharma, None

    S. Pearlman, None

    N. Katz, None

    D. White, None

    L. A. Pirofski, None

    B. Ostrowsky, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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