TY - JOUR
T1 - Impact of Pharmacist-Led Antimicrobial Stewardship on Appropriate Antibiotic Prescribing in the Emergency Department
T2 - A Systematic Review and Meta-Analysis
AU - Kooda, Kirstin
AU - Canterbury, Elizabeth
AU - Bellolio, Fernanda
N1 - Publisher Copyright:
© 2021 American College of Emergency Physicians
PY - 2022/4
Y1 - 2022/4
N2 - Study objective: The aim of this study was to evaluate the impact of pharmacist presence or pharmacist-led antimicrobial stewardship interventions on appropriate prescribing of antibiotics in the emergency department (ED). Methods: Systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were conducted. Studies describing the role of pharmacists and their association with antimicrobial stewardship in the ED were included. The comparator for pharmacist intervention was hours without a pharmacist present, preprotocol implementation, and nonpharmacist culture follow-up. Results: In total, 24 studies (9,984 patients) were included in the qualitative synthesis, and 22 studies (5,791 patients) had data for the primary outcome and were included for the quantitative assessment (meta-analysis). Appropriate prescribing of antibiotics was more likely with pharmacist intervention (22 studies; odds ratio [OR], 3.47; 95% confidence interval [CI] 2.39 to 5.03), particularly among patients with pneumonia (5 studies; OR, 3.74; 95% CI 2.14 to 6.54) or urinary tract infection (4 studies; OR, 1.76; 95% CI 1.24 to 2.50). Time to culture review was similar with or without pharmacist intervention. Time to appropriate antibiotic was shorter with pharmacist intervention (mean difference, 18.9 hours; 95% CI 11.9 to 25.9; P<.001). Repeat ED visit for the same complaint was not significant (10 studies; OR, 0.65; 95% CI 0.39 to 1.10). Conclusion: Pharmacist presence and pharmacist-led antimicrobial stewardship interventions appear to be effective for the appropriate prescribing of antibiotics in adult patients presenting to EDs with a variety of infectious syndromes.
AB - Study objective: The aim of this study was to evaluate the impact of pharmacist presence or pharmacist-led antimicrobial stewardship interventions on appropriate prescribing of antibiotics in the emergency department (ED). Methods: Systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were conducted. Studies describing the role of pharmacists and their association with antimicrobial stewardship in the ED were included. The comparator for pharmacist intervention was hours without a pharmacist present, preprotocol implementation, and nonpharmacist culture follow-up. Results: In total, 24 studies (9,984 patients) were included in the qualitative synthesis, and 22 studies (5,791 patients) had data for the primary outcome and were included for the quantitative assessment (meta-analysis). Appropriate prescribing of antibiotics was more likely with pharmacist intervention (22 studies; odds ratio [OR], 3.47; 95% confidence interval [CI] 2.39 to 5.03), particularly among patients with pneumonia (5 studies; OR, 3.74; 95% CI 2.14 to 6.54) or urinary tract infection (4 studies; OR, 1.76; 95% CI 1.24 to 2.50). Time to culture review was similar with or without pharmacist intervention. Time to appropriate antibiotic was shorter with pharmacist intervention (mean difference, 18.9 hours; 95% CI 11.9 to 25.9; P<.001). Repeat ED visit for the same complaint was not significant (10 studies; OR, 0.65; 95% CI 0.39 to 1.10). Conclusion: Pharmacist presence and pharmacist-led antimicrobial stewardship interventions appear to be effective for the appropriate prescribing of antibiotics in adult patients presenting to EDs with a variety of infectious syndromes.
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U2 - 10.1016/j.annemergmed.2021.11.031
DO - 10.1016/j.annemergmed.2021.11.031
M3 - Review article
C2 - 35039180
AN - SCOPUS:85122994108
SN - 0196-0644
VL - 79
SP - 374
EP - 387
JO - Annals of emergency medicine
JF - Annals of emergency medicine
IS - 4
ER -