ED Antimicrobial Stewardship Interventions Reduces Antibiotic Duration and Improves Selection for Discharged Adult and Pediatric Patients with Skin and Soft Tissue Infections 

According to the Centers for Disease Control and Prevention, antibiotic-resistant bacteria cause two million illnesses and approximately 23,000 deaths each year in the United States.  A recent White House Executive Order, in addition to IDSA/SHEA practice guidelines, recommend expanding antimicrobial stewardship to ambulatory care settings, including emergency departments (ED) and urgent care (UC) centers, where antibiotic prescribing is highly unregulated. Each year 10 million antibiotic prescriptions are written from the emergency department, many of which are inappropriate. Strategies are desperately needed to reduce inappropriate antibiotic use, associated adverse events,  and development of local resistance in acute care outpatient settings. A majority of physicians administer empiric antibiotic treatment that is non-compliant with guidelines, leading to potential patient harm and fueling the emergence of antibiotic resistance. The ED is a deserving focus of antimicrobial stewardship yet interventions have infrequently been adapted to this setting. Skin and soft tissue infections (SSTI) account for 2.4 million annual U.S. emergency department (ED) visits and antibiotic selection is frequently non-adherent to guidelines along with longer than recommended duration of therapy.  We evaluated a quasi-experimental study of a multifaceted antimicrobial stewardship intervention at an academic ED in the setting of high prevalence of clindamycin resistance among S. aureus. Our intervention included educational presentations by a physician champion, implementation of an electronic order set based on 2014 IDSA guidelines, dissemination of an ED specific S. aureus wound isolate antibiogram, monthly departmental peer-comparisons, and bimonthly, confidential, individual audit and feedback. Visits with ICD-10 codes for cutaneous abscess or other SSTI for patients discharged to home from the ED for consented providers were included for program effectiveness analysis. In addition, physicians and patients were surveyed regarding their satisfaction with the program.

Publication Date: 
University of California Davis
Toolkit Category: 
Clinician Initial Evaluation
Disposition Decision
Clinical Areas Affected: 
Emergency Department
Staff Involved: 
ED Staff