Comparison of emergency department to hospital antibiograms: Influence of patient risk factors on susceptibility.
Am J Emerg Med. 2019 Aug 22;:158403
Authors: Miller JL, George A, Kozmic SE, Begano…
Linezolid versus vancomycin in Methicillin Resistant Staphylococcus aureus nosocomial pneumonia in the elderly.
Am J Emerg Med. 2017 May 26;:
Authors: Dupont J, Prat D, Sztrymf B
Comparison of urinary tract infection antibiograms stratified by emergency department patient disposition.
Am J Emerg Med. 2017 Mar 23;:
Authors: Grodin L, Conigliaro A, Lee SY, Rose M, Sinert R
Urine culture guided antibiotic interventions: A pharmacist driven antimicrobial stewardship effort in the emergency department.
Am J Emerg Med. 2016 Dec 16;:
Authors: Zhang X, Rowan N, Pflugeisen BM, Alajbegovic S
BACKGROUND: Antibiotics are overprescribed for abnormal urine tests including asymptomatic bacteriuria (AB), contributing to rising antimicrobial resistance rates. Pharmacists reviewed urine cultures daily from emergency department (ED) encounters to assess antibiotic appropriateness. We studied antibiotic prescribing practices and assessed compliance to national guidelines, correlations with urine analysis (UA) components, and opportunities for antimicrobial stewardship in the ED.
METHODS: This quality improvement project (QIP) was a prospective cohort study at a community hospital ED, with data collected from finalized urine cultures resulting October 30, 2014 through January 5, 2015. Analyses were conducted using Chi-squared and Fisher Exact tests and stepwise multiple logistic regression.
RESULTS: Urine cultures from 457 encounters were reviewed, of which 136 met the inclusion criteria as non-pregnant and asymptomatic for urinary tract infection (UTI). 43% of 136 patients were treated with antibiotics, for a total of 426 antibiotic days. Pharmacist interventions for these patients resulted in 122/426 (29%) of potential antibiotic days saved. Factors found to significantly increase the odds of antibiotic prescribing in asymptomatic patients included presence of leukocyte esterase (OR=4.5, 95% CI: 1.2-17.2; p=0.03) or nitrites (OR=10.8, 95% CI: 1.7-68.1; p=0.01) in the urine and age≥75 (OR=3.5, 95% CI: 1.2-9.6, p=0.02).
DISCUSSION: Pharmacist intervention in discontinuing or modifying antibiotics for asymptomatic patients with urine cultures reduced unnecessary antibiotic exposure and was a first step in antimicrobial stewardship efforts in the ED. Future work includes limiting urine tests and subsequent antibiotic therapy for non-pregnant asymptomatic patients.
PMID: 28010959 [PubMed – as supplied by publisher]
Toxic shock syndrome due to methicillin-resistant Staphylococcus aureus infection after a pediatric scald burn.
Am J Emerg Med. 2015 Dec 23;
Authors: Garland M, Zeller KA, Shetty AK
Pediatric acute osteomyelitis in the postvaccine, methicillin-resistant Staphylococcus aureus era.
Am J Emerg Med. 2015 Jul 17;
Authors: Ratnayake K, Davis AJ, Brown L, Young TP
Impact of an antimicrobial stewardship intervention on urinary tract infection treatment in the ED.
Am J Emerg Med. 2015 May 2;
Authors: Percival KM, Valenti KM, Schmittling SE, Strader BD, Lopez R…
The effects of an electronic order set on vancomycin dosing in the ED.
Am J Emerg Med. 2015 Jan;33(1):92-4
Authors: Hall AB, Montero J, Cobian J, Regan T
OBJECTIVE: The objective of the study was to assess the impact of a computer physician order entry (CPOE) electronic order set on appropriate vancomycin dosing in the emergency department (ED).
METHODS: We conducted a retrospective study examining ED dosing of vancomycin before and after the implementation of an electronic weight-based vancomycin order set. Preimplementation and postimplementation patient records were analyzed between the dates of June 1st and August 31st 2010 for the pre-CPOE group and January 1st to March 31st 2013 for the post-CPOE group.
STATISTICAL ANALYSIS: χ(2) analysis, Fisher exact test, and t tests were performed with a 2-sided P value <.05 denoting statistical significance, where appropriate.
RESULTS: A total of 597 patients were included in the study, with 220 in the pre-CPOE group and 377 in the post-CPOE group. The use of the electronic order set resulted in a 21.9% increase (P < .05) in appropriate dosing with 67.4% (254/377) of post-CPOE vancomycin doses considered appropriate vs 45.5% (100/220) in the pre-CPOE group. In critically ill patients, there was a 16.3% increase in appropriate dosing with 44.7% (38/85) in the post-CPOE group compared with 28.4% (19/67) in the pre-CPOE group.
CONCLUSION: The implementation of an electronic order set increased the percentage of ED patients receiving appropriate initial vancomycin doses. The impact of increasing compliance to vancomycin guidelines is in accordance with stewardship principles that promote optimization of antimicrobial dosing based on individual patient characteristics. More studies are needed to assess the relationship between appropriate vancomycin loading doses in the ED and therapeutic outcomes.
PMID: 25445870 [PubMed – indexed for MEDLINE]
Clinical features and impact of empirical therapy in cirrhotic adults with community-onset bacteremia.
Am J Emerg Med. 2014 Nov 28;
Authors: Hsieh CC, Lee CC, Chan TY, Hong MY, Chi CH, Ko WC