Follow-up of emergency department microbiological cultures in the event of organism-antibiotic mismatch

Introduction: Emergency department providers usually prescribe antimicrobials before culture and sensitivity results are known, potentially resulting in a mismatch of the agent’s spectrum of activity and the causative organism, increasing the chances of clinical failure. Appropriate selection of agent, dose and duration in therapy modification after ED discharge is an area suited to pharmacy intervention.

Objectives: This project will first seek to retrospectively characterize the extent of therapeutic mismatches resulting in changes to therapy.

The prospective component of the study will involve pharmacists in the culture follow-up process and evaluate outcomes compared to the retrospective study. Through increasing pharmacist involvement, we hope to improve outcomes.

Study Design: This comparative cohort study compares a nursing-led to a pharmacist-led follow-up process. Patients were included if they were ≥ 18 years old, visited the Alamance Regional Medical Center ED between either 9/1/2014 – 11/30/2014 (retrospective) or 9/1/2015 – 11/30/2015 (prospective), with a culture resulting after discharge. Patients were excluded if they were < 18 years of age.

Methods: A review of retrospective and prospective patients will be conducted to gather baseline data and parameters relating to their ED visit including diagnosis and discharge antibiotic. In the event of a therapeutic mismatch, the time to follow-up and change in therapy will be recorded. Any trends noted in the resistance patterns of isolated bacteria will be noted. Admissions to either the ARMC ED within 96 hours or to an inpatient ward within 30 days will also be recorded.

Results: Preliminary results show that 41.2% (45/109) of subsequent lab-confirmed UTIs were treated with fluoroquinolones. In 11% of cases, no antibiotics were given.  

Conclusions: In a community hospital setting, opportunity exists to educate prescribers on narrower spectrum antibiotics in the outpatient treatment of uncomplicated UTIs. Final statistical analysis and conclusions anticipated March 2016.