Clinical Pharmacist Management of Bacteremia in a Community Hospital Emergency Department

Abstract

Background: Bacteremia is a serious condition that leads to high morbidity and mortality. Data describing pharmacist involvement in the management of bacteremia in the emergency department are lacking.

Objective: To determine if pharmacist involvement in the management of bacteremia in the emergency department (ED) led to an increase in appropriate treatment of bacteremia as well as improvements in patient outcomes.

Methods: The primary outcome of this retrospective cohort study was the rate of appropriate treatment of bacteremia. Secondary outcomes included the rate of unplanned, infectious disease-related 90-day admission or readmission to the ED or hospital as well as infectious disease-related 90-day mortality. All patients seen in the ED and subsequently discharged who had a positive blood culture determined not to be a contaminant were included in the study. Patients were analyzed in 2 cohorts: those that were physician managed (107 patients) and those that were pharmacist managed (138 patients).

Results: In the physician-managed cohort, 50 of 107 (47%) patients were treated appropriately compared with 131 of 138 (95%) patients in the pharmacist-managed cohort ( P < 0.0001). There was also a decrease in attributable 90-day admission or readmission in pharmacist-managed patients, which occurred in 4 of 138 patients (2.9%) versus the physician-managed patient cohort in which 13 of 107 patients (12.1%) were readmitted ( P = 0.01). There was no difference in mortality between the groups ( P = 0.8337).

Conclusion: Pharmacist involvement in the management of bacteremia in the ED was associated with higher rates of appropriate treatment and a corresponding decrease in the rates of attributable 90-day admission or readmission to the hospital or ED.

Keywords: bacteremia; emergency department; infectious diseases.