Abstract
Antimicrobial stewardship (ASP) is becoming an increasingly high priority worldwide, yet the emergency department (ED) is an area where stewardship is often neglected. Implementing care bundles, guidelines, and protocols appears to be a rational strategy for ED stewardship given the inherently dynamic and hectic environment of care. Multiple questions still exist such as whether to target certain disease states, optimal implementation of ASP interventions in the ED, and the benefit of unique ED-specific guidelines and protocols. A narrative review was performed on interventions, guidelines, and bundles implemented in the ED setting, in an effort to improve ASP or management of infectious diseases. This review is meant to serve as a framework for the reader to implement these practices at their own institution. We examined various studies related to ASP interventions or care bundles in the ED which included: CNS infections (one study), skin and soft-tissue infections (one study), respiratory infections (four studies), urinary tract infections and sexually transmitted infections (eight studies), sepsis (two studies), culture follow-up programs (four studies), and stewardship in general or multiple infection types (five studies). The interventions in this review were diverse, yet the majority showed a benefit in clinical outcomes or a decrease in antimicrobial use. Care bundles, guidelines, and antimicrobial stewardship interventions can streamline care and improve the management of common infectious diseases seen in the ED.
Highlights
Antimicrobial stewardship is becoming an increasingly high priority worldwide, due to mounting threats of antimicrobial resistance, a dwindling armamentarium of antimicrobials, and progressively complex patient populations [1]
An area of intervention that is often neglected by many Antimicrobial stewardship (ASP) is the emergency department (ED), as evidenced, in part, by the estimated 142,000 annual ED visits due to adverse events associated with antimicrobials and the more than 10% of short-term readmissions due to worsening infection [4,5]
Guidelines, and antimicrobial stewardship interventions can streamline care and improve the management of common infectious diseases seen in the ED
Summary
Antimicrobial stewardship is becoming an increasingly high priority worldwide, due to mounting threats of antimicrobial resistance, a dwindling armamentarium of antimicrobials, and progressively complex patient populations [1]. The ED is unique from a stewardship perspective, in that it encompasses a diverse patient population with disease states ranging in severity which require a rapid diagnosis and care in a fast-paced clinical environment [6]. Clinicians in the ED are often responsible for initiating empiric antimicrobial therapy, often with limited patient-specific clinical information, which lays the foundation for their subsequent admission. This offers a large number of opportunities for stewardship interventions, the strategies utilized need to be unique in relation to conventional inpatient antimicrobial stewardship initiatives.
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