Weiler Hospital, Einstein CampusBRONX, NY - February 9, 2015 - Emergency room use in the US has increased over the last decade, but little is known about appropriate antibiotic use in the emergency department (ED). Early antibiotic stewardship and infectious diseases (ID) consultation in the ED can improve initial antibiotic prescribing, reduce unnecessary antibiotic use, improve patient safety, and yield fewer unnecessary hospital admissions, according to a study by Dr. Theresa Madaline and colleagues in the Division of Infectious Diseases.
Research has shown that over 50% of ED patients are prescribed inappropriate antibiotics for viral upper respiratory tract infections. Dr. Madaline’s study, conducted over a six-month period in early 2014, evaluated 331 patients who entered the Einstein campus (Weiler) ED. Patients who presented with infectious conditions were formally evaluated by an ID physician, and patients who were hospitalized were offered follow-up with an ID specialist.
Theresa F. Madaline, MDMontefiore’s multifaceted interdisciplinary antibiotic stewardship program was initiated in 2008 on the Moses Campus under the direction of ID specialist Dr. Belinda Ostrowsky, and expanded to the Children’s Hospital at Montefiore (CHAM, directed by Dr. Iona Munjal) and to the Wakefield Campus (directed by Dr. Priya Nori) in 2013. The ASP is interdisciplinary, interdepartmental, and highly collaborative, connecting physicians, surgeons, operating room nurses, pharmacists, infection control experts, microbiologists, epidemiologists and quality improvement staff. The program fosters judicious antimicrobial use toward better patient care and safety; improved clinical outcomes; reduced resistance; and fewer healthcare-acquired infections such as C. difficile colitis. Education focuses on appropriate testing to diagnose infections, choosing the correct antibiotic regimen, and knowing when to obtain consultation on infectious diseases.
Dr. Madaline’s study, presented this past October at the annual IDWeek meeting in Philadelphia, drew upon previous findings that ED utilization in the US has increased over the last ten years, in the setting of primary care access barriers; that selection and timely administration of effective antibiotics reduced morbidity and mortality in patients with severe sepsis; and that ID consultation in the first two days of admission resulted in lower mortality rates, reduced readmission rates, shorter length of stay, and fewer ICU days. Results of the Dr. Madaline’s study suggested that physicians in the ED were highly receptive to ASP/ID consultation, with over 90% prescribing the ID-recommended antibiotic regimen.
“This multidisciplinary initiative has improved emergency care by providing optimal antibiotics as early as possible for seriously ill patients. Our goals are to improve clinical outcomes and promote responsible use of antibiotics,” said Dr. Madaline, Assistant Professor of Clinical Medicine and Director of Clinical Infectious Diseases Services at Einstein campus.
Uzma N. Sarwar, MD“This is truly a celebration of groups throughout the hospital working together, and of the power of diversity in program planning,” said Dr. Liise-anne Pirofski, Selma and Jacques Mitrani Professor of Biomedical Research, Professor of Medicine and Microbiology & Immunology and Chief of the Division of Infectious Diseases.
So positive has been the reception to ASP/ID in the ED, in fact, that Dr. Uzma Sarwar was recruited to the Division to work with Dr. Madaline to manage and further develop this program. Trained at Stony Brook University (undergraduate and medical school), NYU School of Medicine (residency), and Columbia University and the National Institutes of Health (ID fellowship), Dr. Sarwar has worked extensively on early-phase clinical trials of investigational candidate vaccines for HIV, malaria, Influenza, Ebola, chikungunya, and other emerging infectious diseases. Dr. Sarwar has specific interests in respiratory viral diseases and judicious utilization of viral diagnostics in the ED setting.