A pharmacist-led, post-discharge follow-up program for negative bacterial cultures at a community hospital showed the potential for significantly limiting unnecessary antibiotic exposure, researchers reported last week in the American Journal of Health-System Pharmacy.
The retrospective study, conducted by members of the pharmacy department at a 350-bed community hospital in Michigan that has had an established pharmacist-led culture follow-up program since 2015, reviewed bacterial cultures of adult patients treated and released from the hospital's emergency department (ED) or urgent care (UC) in August 2022. The aim was to characterize the proportion of patients with negative urine culture or chlamydia polymerase chain-reaction (PCR) test results and identify opportunities to de-prescribe antibiotics during follow-up telephone calls. While several studies have evaluated the impact of pharmacist-led follow up on antibiotic therapy with respect to positive cultures, there are no data regarding the impact when cultures are negative.
Of the 398 cultures reviewed, 208 (52%) had negative results, and 50 patients (24%) with negative results were prescribed empiric antibiotics on discharge. The median duration of antibiotic treatment was 7 days, while the median time to culture finalization was 2 days, resulting in an opportunity to save a median of 5 days of antibiotic exposure per patient and 236 total antibiotic days over the month.
Thirty-two patients (15.3%) followed up with their primary care physician within 7 days; of these patients, 1 (0.05%) had their antibiotic prescription discontinued by the primary care physician. There were no documented adverse drug reactions (ADRs).
Annualized, the intervention has the potential to save more than 2,800 days of unnecessary antibiotic therapy, the study authors noted.
"These findings represent a significant antimicrobial stewardship opportunity for pharmacists providing follow-up after ED and UC discharge to discontinue antimicrobial therapy, limiting unnecessary antimicrobial exposure, decreasing risk for development of resistance, and avoiding ADRs [adverse drug reactions]," they concluded.