CaroMont Regional Medical Center, 2525 Court Dr, Gastonia, NC 28054, United States of America.
CaroMont Regional Medical Center, 2525 Court Dr, Gastonia, NC 28054, United States of America.
Am J Emerg Med. 2024 Feb;76:24-28. doi: 10.1016/j.ajem.2023.11.012. Epub 2023 Nov 11.
The 2021 Surviving Sepsis Campaign Guidelines recommend administration of antimicrobials within the first hour of recognition of sepsis. Over the last decade, several studies have demonstrated improved time-to-antibiotic administration and antibiotic appropriateness when a pharmacist was involved in the care of patients with sepsis. To our knowledge, no studies evaluating the appropriate use of antibiotics in sepsis driven entirely by an Emergency Medicine (EM) Clinical Pharmacist Practitioner (CPP) have been published. The purpose of this study is to evaluate the impact of an EM CPP-driven protocol on antimicrobial interventions in patients with sepsis in the emergency department (ED).
This was a retrospective comparison of patients with sepsis for whom antimicrobials were ordered in the ED without pharmacist intervention to patients whose antimicrobials were ordered by an EM CPP via a sepsis consult to pharmacy. An EM CPP reviewed individual patient profiles for pertinent historical admissions, culture data, and allergy profiles to guide antimicrobial selection for the suspected source of infection and entered orders under their scope of practice with formal documentation in the electronic medical record (EMR). The primary objective of this study was to compare the rates of appropriate empiric antibiotic utilization in septic patients admitted from the ED pre- and post-protocol implementation. Secondary endpoints included the following, broadening of ED-initiated empiric antibiotics on hospital admission, time-to-antibiotic administration, in-hospital mortality, Rapid Emergency Medicine Score (REMS) association with in-hospital mortality, and hospital length of stay.
A total of 144 patients were included: 80 patients prescribed antibiotics without pharmacist intervention and 64 prescribed antibiotics by an EM CPP. Appropriate empiric antibiotic selection in the ED improved from 57.5% (46/80) to 86% (55/64) with EM CPP intervention (difference 28.5%; p < 0.01). Time-to-first antibiotic administration decreased by 64 min (p < 0.01). Administration of antibiotics within 60 min, broadening of antibiotics on admission, hospital length of stay, and in-hospital mortality did not significantly differ across groups.
In this small, single-center study, an EM Clinical Pharmacist Practitioner-driven protocol for patients with sepsis in the emergency department improved the rate of appropriate empiric antimicrobial selection and time-to-antibiotic administration.
2021 年脓毒症存活运动指南建议在识别脓毒症后的第一个小时内给予抗菌药物。在过去的十年中，多项研究表明，当药师参与脓毒症患者的治疗时，抗生素的给药时间和抗生素的适当性都有所提高。据我们所知，尚无研究评估完全由急诊医学（EM）临床药师从业者（CPP）驱动的抗生素在脓毒症中的合理使用。本研究的目的是评估 EM CPP 驱动的方案对急诊科（ED）中脓毒症患者抗生素干预的影响。
这是一项回顾性比较研究，比较了在 ED 中未接受药师干预的脓毒症患者与通过脓毒症咨询将抗生素医嘱下达给 EM CPP 药师的患者的抗生素使用情况。EM CPP 药师审查了每位患者的相关入院记录、培养数据和过敏谱，以指导针对疑似感染源的抗生素选择，并在电子病历（EMR）中正式记录他们的医嘱。本研究的主要目的是比较实施方案前后 ED 收治的脓毒症患者经验性使用抗生素的恰当率。次要终点包括：拓宽 ED 入院时经验性抗生素的应用、抗生素给药时间、住院死亡率、快速急诊医学评分（REMS）与住院死亡率的关系以及住院时间。
共纳入 144 例患者：80 例患者在无药师干预的情况下开具抗生素，64 例患者由 EM CPP 开具抗生素。EM CPP 干预后，ED 中经验性抗生素选择的恰当率从 57.5%（46/80）提高到 86%（55/64）（差异 28.5%；p<0.01）。首次抗生素给药时间缩短了 64 分钟（p<0.01）。60 分钟内给予抗生素、入院时抗生素种类的拓宽、住院时间和住院死亡率在各组之间无显著差异。
在这项小型单中心研究中，急诊科由 EM 临床药师从业者驱动的脓毒症患者方案提高了经验性抗菌药物选择的恰当率和抗生素给药时间。
