Antimicrobial Therapy for Pneumonia in the Emergency Department: The Impact of Clinical Pharmacists on Appropriateness
Abstract
Introduction: Pneumonia impacts over four million people annually and is the leading cause of infectiousdisease-related hospitalization and mortality in the United States. Appropriate empiric antimicrobialtherapy decreases hospital length of stay and improves mortality. The objective of our study was to testthe hypothesis that the presence of an emergency medicine (EM) clinical pharmacist improves the timingand appropriateness of empiric antimicrobial therapy for community-acquired pneumonia (CAP) andhealthcare-associated pneumonia (HCAP).
Methods: This was a retrospective observational cohort study of all emergency department (ED) patientspresenting to a Midwest 60,000-visit academic ED from July 1, 2008, to March 1, 2016, who presentedto the ED with pneumonia and received antimicrobial therapy. The treatment group consisted of patientswho presented during the hours an EM pharmacist was present in the ED (Monday-Friday, 0900-1800).The control group included patients presenting during the hours when an EM clinical pharmacist was notphysically present in the ED (Monday-Friday, 1800-0900, Saturday/Sunday 0000-2400 day). We definedappropriate empiric antimicrobial therapy using the Infectious Diseases Society of America consensusguidelines on the management of CAP, and management of HCAP.
Results: A total of 406 patients were included in the final analysis (103 treatment patients and 303 controlpatients). During the hours the EM pharmacist was present, patients were significantly more likely toreceive appropriate empiric antimicrobial therapy (58.3% vs. 38.3%; p<0.001). Regardless of pneumoniatype, patients seen while an EM pharmacist was present were significantly more likely to receiveappropriate antimicrobial therapy (CAP, 77.7% vs. 52.9% p=0.008, HCAP, 47.7% vs. 28.8%, p=0.005).There were no significant differences in clinical outcomes.
Conclusion: The presence of an EM clinical pharmacist significantly increases the likelihood ofappropriate empiric antimicrobial therapy for patients presenting to the ED with pneumonia. [West JEmerg Med. 2017;18(5)856-863.]