PurposeWhile many programs have demonstrated pharmacist-led antimicrobial stewardship successes in inpatient and emergency department (ED) settings, there is a paucity of literature exploring these initiatives in urgent care (UC) sites. This study aimed to determine the impact of implementing a pharmacist-led antimicrobial stewardship program (ASP) in the UC setting.MethodsA retrospective quasi-experimental study was conducted evaluating UC patients with positive urine or wound cultures following discharge. A collaborative practice agreement was implemented in 2015 allowing for pharmacist-led UC culture follow-up via a stewardship-focused protocol. The primary outcome of this study was to compare guideline-concordant antibiotic prescribing between the pre-ASP and post-ASP groups. Secondary outcomes included comparing the number of patients who required follow-up, time to follow-up, UC or ED revisits within 72 hours, and hospital admission within 30 days between groups.ResultsA total of 300 patients were included in the study (pre-ASP, n = 150; post-ASP, n = 150). Total guideline-concordant prescribing for all diagnoses was significantly improved in the post-ASP group (pre-ASP, 41.3% versus post-ASP 53.3%, p = 0.037). Additionally, guideline-concordant antibiotic selection improved in the post-ASP group (pre-ASP, 51% versus post-ASP, 68%, p = 0.01). Follow-up was required for 27 (18%) patients in the pre-ASP group compared with 16 (10.7%) in the post-ASP group (p = 0.07). Median time to follow-up call was longer in the post-ASP group (38 versus 71 hours, p < 0.001). There were no differences in UC and ED revisits within 72 hours (p = 1.0) or hospital admissions within 30 days (p = 0.723).ConclusionA pharmacist-led urgent care ASP was associated with significantly improved guideline-concordant antimicrobial prescribing.

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Introduction Abnormal urinalysis (UA) results, such as pyuria or bacteriuria, increase the risk for antibiotic treatment even in the absence of urinary symptoms. In the emergency department (ED), patients presenting with psychiatric emergencies commonly undergo a medical assessment which includes a UA. We hypothesized that the rate of inappropriate antibiotic treatment for asymptomatic pyuria in the psychiatric medical population would decrease following implementation of an antimicrobial stewardship program (ASP) in the ED. Methods This retrospective cohort study compared the treatment of adult patients presenting to the ED for medical assessment during a psychiatric emergency with noted pyuria between three time periods following implementation of an ASP: early ASP (2014), established ASP (2016), and mature ASP (2018). The ASP provided education and routine audit‐and‐feedback focused on reducing urine testing and eliminating treatment of asymptomatic pyuria. The primary end point was to compare rates of inappropriate treatment of asymptomatic pyuria between groups. Secondary end points included comparing appropriate agent selection and duration for patients who were prescribed antibiotics, prescriber documentation, and patient outcomes between groups. Results A total of 180 patients with pyuria were included; 60 within each study group with 88.3% being asymptomatic. Inappropriate prescribing of antibiotics for asymptomatic patients at ED discharge decreased over time following ASP implementation (2014 = 40.4%, 2016 = 31.4%, 2018 = 17.6%; P = .036). Additionally, documentation noting a positive UA requiring antibiotic treatment decreased (2014 = 46.7%, 2016 = 40%, 2018 = 26.7%). Of the 62 patients treated with antibiotics, selection of a first‐line agent increased with ASP maturity (2014 = 15.4%, 2016 = 26.1%, 2018 = 69.9%; P = .002). Conclusion Inappropriate treatment of asymptomatic pyuria in patients presenting to the ED with psychiatric emergencies decreased significantly over time following implementation of an ASP. EDs may benefit from ASP interventions aimed at decreasing reliance on UA interpretation in this patient population.

BackgroundAntimicrobial resistance is one of the most serious threats to public health. Antimicrobial stewardship initiatives have begun to expand from acute care to ambulatory care settings. While many programs have demonstrated pharmacist-led stewardship successes in inpatient and emergency department (ED) settings, there is a paucity of literature exploring these initiatives in urgent care (UC) sites. This study aimed to determine the impact of implementing a pharmacist-led antimicrobial stewardship program (ASP) in the UC setting.MethodsA retrospective quasi-experimental study was conducted evaluating patients from two health system-affiliated UC sites with positive urine or wound culture results following discharge. In April 2015, the health system’s infectious diseases and ED pharmacists, with support from UC providers, implemented empiric therapy guidelines and a collaborative practice agreement allowing for pharmacist-led culture follow-up via a stewardship-focused protocol. The primary outcome of this study was to compare guideline-concordant antibiotic prescribing (defined as the combination of appropriate agent, dose, and duration of therapy) between the pre-ASP and post-ASP groups. Secondary outcomes included comparing the number of patients who required follow-up, time to follow-up, UC or ED revisits within 72 hours, and hospital admission within 30 days between groups.ResultsThree hundred patients were included in the study (pre-ASP n = 150, post-ASP n = 150). Total guideline-concordant prescribing for all diagnoses was significantly improved in the post-ASP group compared with the pre-ASP group (41.3% vs. 53.3%, P = 0.037). Guideline-concordant antibiotic selection improved in the post-ASP group (51% vs. 68%, P = 0.01) while dose (70 % vs. 74%, P = 0.287) and duration (61% vs. 65%, P = 0.283) were similar between groups. Follow-up was required for 27 (18%) patients in the pre-ASP group vs. 16 (10.7%) in the post-ASP group (P = 0.07), however median time to follow-up call was longer in the post-ASP group (71 vs. 38 hours, P < 0.001). There were no differences between groups in UC (P = 1.0) and ED revisits (P = 1.0) within 72 hours or hospital admissions within 30 days (P = 0.723).ConclusionA pharmacist-led urgent care ASP was associated with significantly improved guideline-concordant antimicrobial prescribing.Disclosures All authors: No reported disclosures.

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