EMERGE: Early antiMicrobial stEwaRdship for GEneral medicine patients-targeting inpatient intravenous therapy greater than 24 hours

Khumra, S; Thomas, A; Vogrin, S; Batrouney, A; Lowe, K; Camilleri, S; Jones, N; Trubiano, JA; Motaganahalli, S; Reynolds, G

Author(s): Khumra, S; Thomas, A; Vogrin, S; Batrouney, A; Lowe, K; Camilleri, S; Jones, N; Trubiano, JA; Motaganahalli, S; Reynolds, G;
Details: Publication Year 2026-03,Volume 6,Issue #1,Page e71
Journal Title: Antimicrobial Stewardship & Healthcare Epidemiology
Publication Type: Research article
Abstract: OBJECTIVE: Early review of intravenous (IV) antimicrobial therapy is central to antimicrobial stewardship (AMS), however scalable models for general medical patients are limited. We evaluated a pharmacist-led digital intervention to optimize IV antimicrobial prescribing. METHODS: A prospective, quasi-experimental before-and-after study was conducted between May 2022 to February 2023 across six general medicine units at a tertiary hospital. AMS recommendations were delivered electronically via Microsoft Teams®. Adult inpatients receiving IV antimicrobials for >24 hours were included, excluding those with COVID-19, under Infectious Diseases consultation or receiving palliative care. The primary outcome was median IV antimicrobial duration. Secondary outcomes included AMS recommendation type, recommendation acceptance, length of stay (LOS), 30-day infection-related readmission, IV therapy recommencement, and inpatient mortality. Antibacterial consumption was analyzed from July 2021 to through December 2024 to evaluate sustained impact. RESULTS: Among 723 antimicrobial orders (474 treatment episodes in 458 patients), median IV duration was comparable between phases (intensive: 2.75 days; baseline: 3.00 days). LOS was shorter during the intensive phase compared to baseline (5.5 vs 7.6 days; P = .04), particularly in patients without bacteremia. Readmissions and mortality were unchanged. Of 400 AMS recommendations, 67% were IV-to-oral switches; overall acceptance was 78%. Piperacillin-tazobactam use declined, and sustained reductions in aminoglycosides, ampicillin and IV flucloxacillin were observed. A reduction in total antibiotic prescribing (combined IV and oral prescribing) was also observed. CONCLUSIONS: The digital pharmacist-led AMS intervention did not reduce IV duration, likely reflecting strong baseline prescribing, but was associated with shorter LOS and a reduction in total antibacterial use. This program offered a scalable, sustainable alternative to resource-intensive face-to-face models.
Publisher: Cambridge University Press
Department(s): Infectious Diseases
Publisher's Version: https://doi.org/10.1017/ash.2026.10313
Open Access at Publisher's Site: https://doi.org/10.1017/ash.2026.10313
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-05-19 02:35:04

Last Modified: 2026-05-19 02:35:24