Background: Current evidence demonstrates that a significant proportion of prescriptions for antibiotics that originate from the emergency department (ED) are inappropriate. Urinary tract infections (UTIs) are a frequent indication for prescribing an antibiotic in the ED. The Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS) piloted a pharmacistled ED aftercare program to promote appropriate antimicrobial management of outpatient UTIs.
Methods: A single center, retrospective chart review included veterans discharged with an oral antibiotic for UTI treatment from the VAGLAHS ED and evaluated by clinical pharmacists between June 1, 2021, and June 30, 2022. For patients with multiple ED visits, only the initial ED encounter was reviewed. Patients were excluded if they had a complicated UTI diagnosis requiring intravenous antibiotics or if they were admitted to the hospital.
Results: Of 449 veterans with an index UTI ED aftercare follow-up, 200 patients were evaluated. A cystitis diagnosis was made for 132 patients (66.0%) and 121 (60.5%) were empirically prescribed β-lactams. For 98 of 133 (73.6%) cases, appropriate empiric antibiotic selection led to no changes in index therapy. Sixty-seven cases required pharmacist intervention. Therapy modifications were made for 34 (17.0%) patients and 33 (16.5%) patients discontinued treatment. Discontinued therapy helped patients avoid 144 days of antibiotic exposure. Twelve (6.0%) patients had a subsequent urinary-related ED visit within 30 days.
Conclusions: Implementation of a pharmacist-driven UTI ED aftercare program at a US Department of Veterans Affairs medical center reduced unnecessary antimicrobial exposure and improved antibiotic management of UTIs.
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