PSHP 2026 Residency Conference

Purpose: To evaluate the frequency and address any contributing factors associated with inappropriate empiric antibiotic prescribing in the Emergency Department (ED) based on national and institutional guidelines.
Methods: A retrospective record review was conducted at St. Mary Medical Center of electronic patient health records from January 1, 2025- June 30, 2025. Adults aged 18-89 years presenting to the ED with suspected or confirmed pneumonia (PNA) or urinary tract infection (UTI), who received pre-identified broad-spectrum antibiotics were included. The primary outcome looked at frequency of inappropriate empiric broad-spectrum antibiotic prescribing in the ED. Secondary outcomes included post ED antimicrobial course, hospital length of stay (LOS), and subgroup analyses of patients who met SIRS criteria and those with multidrug-resistant organism (MDRO) risk factors. Safety endpoints included adverse drug reactions and mortality. Initial treatment strategy was assessed based on the 2019 American Thoracic Society pneumonia guidelines, and 2010 Infectious Diseases Society of America UTI guidelines with local resistance pattern guidance.  
Results: Of the 166 patients included, 98 (59%) received antibiotics for PNA and 68 (41%) for UTI. Overall, 108 (65%) received inappropriate empiric antibiotics. In the inappropriate group, 71 (66%) met SIRS criteria, of which 1 (0.9%) had septic shock. Anti-MRSA antibiotics were discontinued in 57 (53%) patients, and antipseudomonal therapy was narrowed in 54 (50%) patients. Vancomycin was administered to 89 (54%) patients, despite only 16 patients meeting criteria for empiric MRSA coverage. Common MDRO risk factors were IV antibiotic use within 90 days and prior MDRO positive cultures within 1 year. The inappropriate group also had a longer mean LOS by 57 hours. Acute kidney injury occurred in 7 (6%) patients, and 3 (3%) patients died. 
Conclusion: Inappropriate empiric treatment was associated with providing unnecessary gram positive and gram-negative coverage, indicating a pattern of reflexive broad-spectrum prescribing. Targeted education on current national and institutional practice guidelines may reduce unnecessary broad-spectrum antibiotic use and reduce antimicrobial resistance.