Antimicrobial Stewardship in the Emergency Department: Evaluation of Discharge Antibiotic Prescribing for UTI and CAP
Delaney Peterson, Mckenzie Hodges, Courtney McDonald, Emma Hornsby, Aayush Patel, Lauren Simmons
Piedmont Columbus Regional Midtown (PCRM) - Columbus, Georgia
Background: Antibiotics are among the most frequently prescribed medications at emergency department (ED) discharge. Community-acquired pneumonia (CAP) and urinary tract infections (UTIs), including cystitis and pyelonephritis, account for a substantial proportion of ED infectious diagnoses and represent key opportunities for antimicrobial stewardship. This study aimed to evaluate adherence to institutional guidelines for ED discharge antibiotic prescribing for UTIs and CAP and to identify actionable targets for improvement.
Methodology: A retrospective, pre–post intervention chart review was conducted at a single hospital-based emergency department. Adult patients (≥18 years) discharged from the ED with a diagnosis of urinary tract infections (cystitis or pyelonephritis) or community-acquired pneumonia and prescribed oral antibiotics at discharge were included. Patients who left against medical advice, left before evaluation, or had end-of-life or palliative status were excluded. Encounters were reviewed during a pre-intervention period (October 1st–December 31st, 2025) and a post‑intervention period (February 1st–March 24th, 2026) following implementation of an updated institutional treatment guideline with accompanying antimicrobial stewardship education. The primary outcome was guideline compliance of discharge antibiotic prescriptions, defined by appropriate drug selection, dose, and duration. Secondary outcomes included the frequency and types of guideline non-compliance. To ensure feasibility and minimize bias, we used stratified random sampling to select equal numbers of eligible encounters per phase and per diagnosis, with UTIs further stratified as cystitis or pyelonephritis.
Results: In Progress
Conclusion: In Progress
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