Antibiotic Stewardship in the Emergency Department

Core Strategies for ED Antibiotic Stewardship

The American College of Emergency Physicians recommends biomarker testing and rapid pathogen testing to improve antibiotic prescribing decisions for patients presenting with infectious syndromes 3, 4
Blood cultures should be obtained selectively in patients with community-acquired pneumonia, urinary tract infections, or skin/soft tissue infections, particularly when signs of sepsis are absent 4
Rapid diagnostic testing helps distinguish between viral and bacterial pathogens, reducing unnecessary antibiotic use and enabling appropriate narrow-spectrum therapy when indicated 5
Watchful waiting or delayed antibiotic prescribing should be considered for select patients with lower respiratory tract infections, acute COPD exacerbations, uncomplicated cystitis, or diverticulitis 4, 6
Structured culture follow-up programs should be implemented for patients discharged from the ED with pending cultures to ensure appropriate antibiotic therapy adjustments 4, 6
Shortening duration of therapy according to current guidelines reduces selective pressure for resistant bacteria without compromising outcomes 5
Dose optimization based on patient characteristics, pathogen, infection site, and pharmacokinetic/pharmacodynamic properties improves efficacy and reduces resistance 5

ED clinician representation on hospital antimicrobial stewardship committees is essential for successful implementation 7
Collaboration between ED clinicians, pharmacists, microbiologists, and infectious disease specialists yields the most effective stewardship programs 7
A dedicated pharmacist as part of the ED team plays a critical role in addressing appropriate antibiotic use 8
Active educational programs including seminars and roundtable discussions promote dialogue and clinician engagement 7
Educational messaging should be tailored to ED-specific practice patterns and challenges 7
Inclusion of infectious disease topics in departmental grand rounds and inter-specialty conferences facilitates improved antibiotic use 7
Process and outcome measures should track antimicrobial utilization and resistance patterns 7
Post-prescription review with patient follow-up ensures appropriate transitions to outpatient care 5
Monitoring appropriateness of antibiotic therapy choice, rehospitalization rates, and time to culture review helps evaluate program effectiveness 6

Adapt implementation strategies to the specific settings and circumstances of individual EDs 2
Acknowledge the tension between appropriate broad-spectrum antibiotic use for life-threatening infections and antimicrobial stewardship goals 7
Failure to address barriers to implementation can hinder uptake of recommended practices, and understanding these barriers is crucial for successful implementation 1, 9