Expansion of a Pharmacist-Led Culture Follow-Up Program to Real-Time Notification of Multidrug-Resistant Microbiology Results in the Emergency Department

Author:

Andrade Justin1ORCID,Truong James2,Ciaramella Christine2

Affiliation:

1. Touro College of Pharmacy, New York, NY, USA

2. The Brooklyn Hospital Center, Brooklyn, NY, USA

Abstract

Introduction: There are currently limited published data for a pharmacist-led multidrug-resistant (MDR) culture follow-up program through a collaborative drug therapy management (CDTM) agreement in the emergency department (ED). Objective: The objective of this study was to assess the impact of a pharmacist-led culture follow-up program for MDR microbiology results on ED revisit rate. Methods: A single-center quasi-experimental retrospective study was conducted comparing the outcomes before (December 2017 to March 2019) and after (April 2019 to July 2020) implementation of the ED MDR Culture program. Patients 18 years of age or older; with confirmed positive microbiology culture of extended-spectrum beta-lactamases (ESBL), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE) at any site; and discharged from the ED were included. The primary outcome was to evaluate ED revisit within 30 days due to antimicrobial treatment failure, defined as lack of resolution or worsening of infection. A statistical analysis was performed for categorical data using Fisher’s exact test, and for continuous data using unpaired t test or Mann-Whitney U Test, when applicable. Results: A total of 130 patients were included in the analysis. Patients in the post-implementation group (n = 70) had a significant reduction in ED revisits compared to the pre-implementation group (n = 60); 9 [12.9%] versus 17 [28.3%], respectively; P = .046. Conclusion: Implementation of an ED MDR culture program was associated with significantly less ED revisits within 30 days due to antimicrobial treatment failure, thus demonstrating the expanded role of ED pharmacists in antimicrobial stewardship in the outpatient setting.

Funder

New York State Council of Health-system Pharmacist Research and Education Foundation.

Publisher

SAGE Publications

Subject

Pharmacology (medical),Pharmacology,Pharmacy

Reference19 articles.

1. Centers for Disease Control and Prevention. Core Elements of Hospital Antibiotic Stewardship Programs. US Department of Health and Human Services, CDC; 2014. Updated March 4, 2014. Accessed September 9, 2014. http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html.

2. Antibiotic Utilization for Acute Respiratory Tract Infections in U.S. Emergency Departments

3. Demographic and Treatment Patterns for Infections in Ambulatory Settings in the United States, 2006-2010

4. Pharmacist-driven antimicrobial optimization in the emergency department

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