Impact of a pharmacist-led stewardship intervention for antibiotic prescribing in the emergency department

<h2>Abstract</h2><h3>Background</h3> Antibiotics are commonly prescribed in emergency departments but limited studies have been published describing antimicrobial stewardship interventions in this practice area. The purpose of this study was to assess the effectiveness of a multifaceted pharmacist-led antimicrobial stewardship intervention on selection and duration of antibiotics prescribed in the emergency department. <h3>Methods</h3> This single-center, quasi-experimental study evaluated patients discharged from the adult emergency department between October 1, 2021 to February 28, 2022 (preintervention group) and October 1, 2022 to February 28, 2023 (postintervention). Antibiotic default durations were removed from the electronic medical record in September 2022, and education was provided to emergency department prescribers on proper antibiotic selection and duration. Adult patients with a new presumed diagnosis of acute cystitis, acute pyelonephritis, community-acquired pneumonia (CAP), cellulitis, or skin abscess with a new prescription for an oral antibiotic at emergency department discharge were included. The primary outcome was the duration of antibiotic therapy prescribed. <h3>Results</h3> There were 220 patients included (110 preintervention; 110 postintervention). Baseline characteristics were similar between groups, and acute cystitis (45%) was the most common indication. The mean antibiotic duration was low in both groups, and there was no statistically significant difference between pre- and postgroups (6.60 vs. 6.35 days; <i>P</i> = 0.382). A 10% decrease in antibiotic inappropriateness was found in the preintervention to postintervention groups (<i>P</i> = 0.075). <h3>Conclusion</h3> Overall duration was lower than expected in the pre- and postgroups, with most patients receiving less than 7 days of antibiotics for multiple common infections. Several challenges were identified for performing stewardship in the emergency departments and further interventions have been planned based on the results of this study.