Antimicrobial Stewardship in the Emergency Department

doi:10.1016/j.emc.2018.06.012

Review

. 2018 Nov;36(4):853-872.

doi: 10.1016/j.emc.2018.06.012. Epub 2018 Sep 6.

Antimicrobial Stewardship in the Emergency Department

Michael Pulia¹, Robert Redwood², Larissa May³

Affiliations

¹ BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Drive, Suite 300, Madison, WI 53705, USA. Electronic address: mspulia@medicine.wisc.edu.
² Department of Family Medicine and Community Health, University of Wisconsin Madison School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715.
³ Department of Emergency Medicine, University of California Davis, 4150 V Street, Suite 2100, Sacramento, CA 95817, USA.

PMID: 30297009
PMCID: PMC7094813
DOI: 10.1016/j.emc.2018.06.012

Review

Antimicrobial Stewardship in the Emergency Department

Michael Pulia et al. Emerg Med Clin North Am. 2018 Nov.

. 2018 Nov;36(4):853-872.

doi: 10.1016/j.emc.2018.06.012. Epub 2018 Sep 6.

Authors

Michael Pulia¹, Robert Redwood², Larissa May³

Affiliations

¹ BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Drive, Suite 300, Madison, WI 53705, USA. Electronic address: mspulia@medicine.wisc.edu.
² Department of Family Medicine and Community Health, University of Wisconsin Madison School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715.
³ Department of Emergency Medicine, University of California Davis, 4150 V Street, Suite 2100, Sacramento, CA 95817, USA.

PMID: 30297009
PMCID: PMC7094813
DOI: 10.1016/j.emc.2018.06.012

Abstract

The emergency department (ED) is the hub of the US health care system. Acute infectious diseases are frequently encountered in the ED setting, making this a critical setting for antimicrobial stewardship efforts. Systems level and behavioral stewardship interventions have demonstrated success in the ED setting but successful implementation depends on institutional support and the presence of a physician champion. Antimicrobial stewardship efforts in the ED should target high-impact areas: antibiotic prescribing for nonindicated respiratory tract conditions, such as bronchitis and sinusitis; overtreatment of asymptomatic bacteriuria; and using two antibiotics (double coverage) for uncomplicated cases of cellulitis or abscess.

Keywords: Antibiotics; Antimicrobial stewardship; Emergency department; Infectious diseases; Quality improvement.

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Ladines-Lim JB, Fischer MA, Linder JA, Chua KP. Ladines-Lim JB, et al. Antimicrob Steward Healthc Epidemiol. 2024 May 14;4(1):e79. doi: 10.1017/ash.2024.79. eCollection 2024. Antimicrob Steward Healthc Epidemiol. 2024. PMID: 38751940 Free PMC article.
Antimicrobial Stewardship in the Emergency Department Observation Unit: Definition of a New Indicator and Evaluation of Antimicrobial Use and Clinical Outcomes.
Guisado-Gil AB, Mejías-Trueba M, Peñalva G, Aguilar-Guisado M, Molina J, Gimeno A, Álvarez-Marín R, Praena J, Bueno C, Lepe JA, Gil-Navarro MV, Cisneros JM. Guisado-Gil AB, et al. Antibiotics (Basel). 2024 Apr 12;13(4):356. doi: 10.3390/antibiotics13040356. Antibiotics (Basel). 2024. PMID: 38667032 Free PMC article.
Empirical antimicrobial prescribing for pyelonephritis in patients discharged from 15 US Emergency Departments: an opportunity for improvement.
Rech MA, Faine BA, Gross AE, Vakkalanka P, Brown CS, Harding SJ, Slocum G, Zimmerman D, Zepeski A, Rewitzer S, Howington GT, Campbell M, Dawson J, Treu CN, Nelson L, Jones M, Flack T, Porter B, Sarangarm P, Mattson AE, Bailey A, Kelly G, Talan DA. Rech MA, et al. J Antimicrob Chemother. 2024 May 2;79(5):1038-1044. doi: 10.1093/jac/dkae070. J Antimicrob Chemother. 2024. PMID: 38482607 Free PMC article.
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References

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[1] McGowan JE Jr. Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev Infect Dis. 1983;5(6):1033–1048. - PubMed

[2] McGowan JE Jr. Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev Infect Dis. 1983;5(6):1033–1048. - PubMed

[3] WHO | Global action plan on antimicrobial resistance. WHO; http://apps.who.int/iris/bitstream/10665/193736/1/9789241509763_eng.pdf?.... Accessed March 2, 2018.

[4] WHO | Global action plan on antimicrobial resistance. WHO; http://apps.who.int/iris/bitstream/10665/193736/1/9789241509763_eng.pdf?.... Accessed March 2, 2018.

[5] Collignon PC, Conly JM, Andremont A, et al. World Health Organization Ranking of Antimicrobials According to Their Importance in Human Medicine: A Critical Step for Developing Risk Management Strategies to Control Antimicrobial Resistance From Food Animal Production. Clin Infect Dis. 2016;63(8):1087–1093. doi:10.1093/cid/ciw475 - DOI - PubMed

[6] Collignon PC, Conly JM, Andremont A, et al. World Health Organization Ranking of Antimicrobials According to Their Importance in Human Medicine: A Critical Step for Developing Risk Management Strategies to Control Antimicrobial Resistance From Food Animal Production. Clin Infect Dis. 2016;63(8):1087–1093. doi:10.1093/cid/ciw475 - DOI - PubMed

[7] National Strategy to Combat Antibiotic Resistance. https://www.cdc.gov/drugresistance/federalengagement-in-ar/national-stra.... Accessed March 2, 2018.

[8] National Strategy to Combat Antibiotic Resistance. https://www.cdc.gov/drugresistance/federalengagement-in-ar/national-stra.... Accessed March 2, 2018.

[9] The FAO Action Plan on Antimicrobial Resistance: 2016-2020. United Nations; http://www.fao.org/3/a-i5996e.pdf. Accessed March 2, 2018.

[10] The FAO Action Plan on Antimicrobial Resistance: 2016-2020. United Nations; http://www.fao.org/3/a-i5996e.pdf. Accessed March 2, 2018.

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Antimicrobial Stewardship in the Emergency Department

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Antimicrobial Stewardship in the Emergency Department

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