SAN FRANCISCO – Blood and urine culture results need to be followed up in emergency department patients discharged on empiric antibiotic therapy.
During a 4-month prospective study, pharmacists at the Henry Ford Hospital in Detroit found antibiotic-bacteria mismatches in 26% of 196 ED patients based on cross-checking of culture results and antibiotics prescribed.
When alerted to the problems, physicians called the patients to change their antibiotic regimens based on the pharmacists’ recommendations.
Alex Otto/IMNG Medical Media
Lisa Dumkow, Pharm.D.
Compared to 124 well-matched historical controls who did not get the extra oversight, the 196 patients had a 7% combined decrease in 72-hour ED revisits and 30-day admissions (17% vs. 10%, P = .08). Among uninsured patients, ED revisits dropped more than 10% (15% vs. 2%, P = .04).
The situation isn’t unique to Henry Ford. Empiric treatment is common pending culture results, and sometimes even the best guesses are wrong, said lead investigator Lisa Dumkow, Pharm.D., a pharmacy resident at Henry Ford, at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy . ED physicians had been struggling with culture follow-up and the hospital pharmacists "were really excited to have us there to help them. It was nice for patient satisfaction, too. Some of the patients were appreciative."
Most of the patients in the study were women with urinary tract infections caused by Escherichia coli.
The majority of pharmacist interventions were for pathogen nonsusceptibility, followed by inappropriate dose, or duration of antibiotic therapy.
The conference was sponsored by the American Society for Microbiology. The researchers said they have no disclosures.