An antibiotic stewardship program in the emergency department decreased piperacillin-tazobactam use and increased guideline-concordant antibiotic prescribing for uncomplicated cystitis
Antimicrobial stewardship programs aim to optimize antibiotic use to improve patient outcomes. Data regarding the impact of stewardship efforts in the Emergency Department (ED) are limited. We extended our inpatient antimicrobial stewardship program to our ED and report on antibiotic use before and after this initiative.
We developed a quarterly report of antibiotics administered standardized by 1000 patient encounters (PE) to monitor use over time. Initial interventions were focused in two areas: 1) Prospective audit and feedback to decrease unnecessary use of piperacillin-tazobactam (pip-tazo) was initiated in 10/2012. Cefepime was the recommended anti-pseudomonal agent, where appropriate. 2) Increasing adherence to treatment guidelines for uncomplicated cystitis, beginning in 1/2013. Nitrofurantoin was the recommended first-line agent. To measure the impact of these interventions on antibiotic utilization, we performed a retrospective pre/post-intervention evaluation of adults >18 years who received at least one dose of an antibiotic in the ED. Days of antibiotic therapy (DOT)/1000 PE were compared between time periods using interrupted time-series analysis to detect changes in level and trend before and after the intervention.
Pip-tazo use was significantly decreased by -3.2 DOT/1000 PE (95% CI -5.8 to -0.7) immediately after the intervention (p=0.02). Cefepime use increased by 1.9 DOT/1000 PE (95% CI -0.8 to +4.7) immediately after the intervention (p=0.05). Among cases identified with uncomplicated cystitis, nitrofurantoin use significantly increased by 8.3 DOT/100 cases (95% CI 0.9-15.8) immediately after the intervention (p=0.03). Cephalexin use decreased by -15.8 DOT/1000 cases (95% CI -32.5 to +0.8) immediately after the intervention, (p=0.05).
Antibiotic stewardship initiatives can result in rapid practice change in the ED which can be monitored through use of longitudinal antibiotic utilization data. Future interventions should aim to expand the focus of antibiotic stewardship initiatives in the ED.
K. Kaucher, None
K. Shihadeh, None
J. Sankoff, None
T. Jenkins, None