1897. Impact of Pharmacist Led Culture Review in the Emergency Department for Discharged Patients Warranting Antimicrobial Regimen Modification
Session: Poster Abstract Session: Antibiotic Stewardship: Outpatient and ED
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • 2016IDWeekposterV0.3.pdf (155.8 kB)
  • Background:Studies incorporating an emergency medicine pharmacist (EPh) into culture review in the emergency department (ED) have demonstrated stewardship benefits. This study aims to evaluate outcomes of an EPh-managed culture follow-up program for patients discharged from the ED.

    Methods:This was a single center, retrospective, interventional study of patients discharged from the ED with urinary tract (UTIs) or skin-and-soft-tissue infections (SSTIs) warranting antimicrobial regimen modification. Eight-month time periods were compared before and after transition to an EPh-led culture follow-up. Primary outcome was number of antibiotic days of therapy prescribed. Secondary outcomes were appropriateness of therapy with respect to agent and duration of therapy, medication-related adverse events, and 30-day readmissions. Mann-Whitney U and chi-squared statistical tests were used to analyze primary and secondary outcomes, respectively.

    Results: A total of 173 patients met study inclusion, 118 in the pre-EPh and 55 in the post-EPh group. The median number of antibiotic days prescribed for cystitis was 5 [5, 7] and 5 [3, 5] in the pre and post-EPh groups, respectively (p=0.014, Table 1). Although medians were equal, the result was significant due to overall shorter durations of antibiotic therapy prescribed in the post-EPh group. Similarly, median antibiotic days prescribed for pyelonephritis/complicated UTI (cUTI) was significantly reduced from 10 [7, 14] in the pre-EPh group to 7 [7, 10] days in the post-EPh group, p=0.034. Appropriate prescribing significantly increased from 71.2% to 85.5% of overall cases in the post-EPh group compared to the pre-EPh group, p=0.042. There was no difference in medication-related adverse events and 30-day readmissions.

    Conclusion: Addition of a pharmacist to a culture follow-up program in the ED resulted in a decreased number of antibiotic days prescribed for discharged patients warranting antimicrobial regimen modification for UTIs and increased appropriate prescribing for UTIs and SSTIs. Table 1. Duration of antibiotic therapy in days.

    Infection

    Pre-EPh

    (n=118)

    Post-EPh

    (n=55)

    p-value

    No.

    Median [IQR]

    No.

    Median [IQR]

    Cystitis

    65

    5 [5, 7]

    18

    5 [3, 5]

    0.014

    Pyelonephritis/cUTI

    28

    10 [7, 14]

    18

    7 [7, 10]

    0.034

    SSTI

    25

    10 [7, 10]

    19

    7 [7, 10]

    0.203

    Ian Karall, PharmD, Pharmacy, Rush University Medical Center, Chicago, IL, Gary Peksa, PharmD, BCPS, Pharmacy & Emergency Medicine, Rush University Medical Center, Chicago, IL and Kate Starosta, PharmD, BCPS, Pharmacy, Henry Ford Hospital, Detroit, MI

    Disclosures:

    I. Karall, None

    G. Peksa, None

    K. Starosta, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.