Antimicrobial Stewardship in Emergency Departments: Strategies to Reduce Antibiotic Resistance and Enhance Clinical Outcomes

Antibiotic resistance constitutes a worldwide public health emergency with lasting implications on selective treatment regimens, increasing costs of health care, and overall patient morbidity and mortality. Increasing rates of multi-drug resistant (MDR) bacteria, which are accelerated by inappropriate (or excessive) use of antimicrobials, pose an enormous threat to continued control over infections. Antimicrobial stewardship programs (ASPs) are new strategies that promote a balance between antibiotic prescribing optimization, prevention of emergent resistance, and clinical improvement. ASPs have been widely implemented in inpatient and outpatient settings, but have only been applied in hospital emergency departments (EDs). EDs frequently start antibiotic therapy and manage infections with an understanding of the dynamic nature of patient flow. This study analyzes the ED, pressures of MDR due to the increased frequency of extended-spectrum β-lactamase (ESBL) producing isolates, and current use of antibiotics (which can be inappropriate in 25–50% of presentations). We explore key measures of ASP and its impact on monitoring antimicrobial use and clinical outcomes, and provide examples of evidence-based strategies tailored to the realities of ED practice. They entail multidisciplinary stewardship teams, quick diagnostic tests, culture follow-up programs, local resistance profiling, and targeted education. Although there is evidence for improved prescribing by ASPs, heterogeneity in interventions and outcome measures underscores the need for standard strategies. With the deployment of tailored ASPs, EDs can restrict MDR propagation, optimize patient care, and aid global resistance control programs.