The following is a summary of “Impact of emergency medicine clinical pharmacist practitioner-driven sepsis antibiotic interventions,” published in the February 2024 issue of Emergency Medicine by Hammond, et al.

The 2021 Surviving Sepsis Campaign Guidelines emphasize administering antimicrobials promptly within the first hour of sepsis recognition. Studies have shown improved time-to-antibiotic administration and antibiotic appropriateness with pharmacist involvement in sepsis care. However, limited research exists on the impact of Emergency Medicine (EM) Clinical Pharmacist Practitioners (CPPs) on antibiotic use in sepsis management. For a study, researchers sought to evaluate the effect of an EM CPP-driven protocol on antimicrobial interventions in patients with sepsis in the emergency department (ED).

The study retrospectively compared patients with sepsis who received antimicrobials in the ED without pharmacist intervention to those whose antimicrobials were ordered by an EM CPP through sepsis consult with the pharmacy. The EM CPP reviewed individual patient profiles, including historical admissions, culture data, and allergy profiles, to guide antimicrobial selection and enter orders within their scope of practice with documentation in the electronic medical record (EMR). The primary objective is to compare appropriate empiric antibiotic utilization rates pre- and post-protocol implementation. Secondary endpoints included a broadening of ED-initiated empiric antibiotics on hospital admission, time-to-antibiotic administration, in-hospital mortality, association of Rapid Emergency Medicine Score (REMS) with in-hospital mortality, and hospital length of stay.

The study includes 144 patients: 80 were prescribed antibiotics without pharmacist intervention, and 64 were prescribed antibiotics by an EM CPP. Appropriate empiric antibiotic selection in the ED increased significantly from 57.5% (46/80) to 86% (55/64) with EM CPP intervention. Time-to-first antibiotic administration decreased by 64 minutes (P < 0.01). However, there were no significant differences in administration of antibiotics within 60 minutes, broadening of antibiotics on admission, hospital length of stay, or in-hospital mortality across groups.

In the single-center study, an EM CPP-driven protocol for sepsis management in the ED improved the appropriate empiric antimicrobial selection rate and time-to-antibiotic administration.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723006198