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BundlED Up: A Narrative Review of Antimicrobial Stewardship Initiatives and Bundles in the Emergency Department

1
Department of Medicine, Division of Infectious Disease, Loyola University Medical Center, Maywood, IL 60153, USA
2
Department of Pharmacy, Maricopa Medical Center, Phoenix, AZ 85008, USA
3
College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA
4
Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL 60153, USA
*
Author to whom correspondence should be addressed.
Pharmacy 2019, 7(4), 145; https://doi.org/10.3390/pharmacy7040145
Received: 24 September 2019 / Revised: 28 October 2019 / Accepted: 30 October 2019 / Published: 1 November 2019
(This article belongs to the Special Issue Antimicrobial Stewardship across the Continuum of Care)
Antimicrobial stewardship (ASP) is becoming an increasingly high priority worldwide, yet the emergency department (ED) is an area where stewardship is often neglected. Implementing care bundles, guidelines, and protocols appears to be a rational strategy for ED stewardship given the inherently dynamic and hectic environment of care. Multiple questions still exist such as whether to target certain disease states, optimal implementation of ASP interventions in the ED, and the benefit of unique ED-specific guidelines and protocols. A narrative review was performed on interventions, guidelines, and bundles implemented in the ED setting, in an effort to improve ASP or management of infectious diseases. This review is meant to serve as a framework for the reader to implement these practices at their own institution. We examined various studies related to ASP interventions or care bundles in the ED which included: CNS infections (one study), skin and soft-tissue infections (one study), respiratory infections (four studies), urinary tract infections and sexually transmitted infections (eight studies), sepsis (two studies), culture follow-up programs (four studies), and stewardship in general or multiple infection types (five studies). The interventions in this review were diverse, yet the majority showed a benefit in clinical outcomes or a decrease in antimicrobial use. Care bundles, guidelines, and antimicrobial stewardship interventions can streamline care and improve the management of common infectious diseases seen in the ED. View Full-Text
Keywords: antimicrobial stewardship; bundle; emergency department; infectious diseases antimicrobial stewardship; bundle; emergency department; infectious diseases
MDPI and ACS Style

Santarossa, M.; Kilber, E.N.; Wenzler, E.; Albarillo, F.S.; Sterk, E.J. BundlED Up: A Narrative Review of Antimicrobial Stewardship Initiatives and Bundles in the Emergency Department. Pharmacy 2019, 7, 145.

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