Outcomes associated with emergency department pharmacists' participation in antimicrobial stewardship

Purpose: To assess outcomes and documentation associated with incorporation of emergency department pharmacists (EPhs) in the antimicrobial culture follow up process.

Methods: Eligible patients were at least 18 years old and assessed by an ED physician (ED MD) in March 2010 or March 2012 with at least one subsequent positive culture addressed by an ED MD, mid-level practitioner (MLP), or EPh after discharge. Data on baseline characteristics, empiric antimicrobials, cultures, definitive therapy, documentation, and readmissions were used in this retrospective descriptive analysis.

Results: 160 cultures were included in this IRB-approved study. Eighty cultures comprised the EPh and non-EPh cohorts. Baseline characteristics were similar between the groups, with a mean age of 45.4 years and 70% female. The most prevalent culture type was urine (EPh 55% vs. non-EPh 63.8%), followed by skin and soft tissue (EPh 32.5% vs. non-EPh 22.5%). Other sources included urogenital, blood, throat, body fluid, stool, and sputum. Thirty-four percent of EPh versus 16.3% of non-EPh cultured organisms were resistant to prescribed empiric antimicrobials. Of those resistant cultures, 81.5% EPh versus 53.8% non-EPh were modified based on susceptibilities, with 100% of modifications in both cohorts appropriate for sensitivities; however, 14.2% in each cohort were not ideal based on renal function or drug interactions. Readmission rates to the ED or hospital within 96 hours were similar (EPh 18.8% vs. non-EPh 16.3%), with the most common reason being wound care. Full documentation of follow up therapy occurred more frequently in the EPh group (97.5% vs. 31.3%), with 31.3% of the non-EPh cohort not having any documentation.

Conclusion: EPh involvement in assessment of culture results and subsequent patient follow up was at least as effective as ED MD or MLP assessment with regards to propriety of definitive therapy and readmission rates. EPh documentation of therapy modifications was more reliable.