A primary limitation of this study is the lack of differentiation between cultures collected from patients with or without indwelling catheters. However, only including patients who presented with signs and/or symptoms of a UTI limits the number of cultures that could potentially be deemed as colonization, thus minimizing the potential for nonpathogenic organisms to confound the results. This study also did not differentiate the setting from which the patient presented (eg, community, extended care facility, etc) that could have potentially provided guidance on resistance patterns for community-acquired UTIs and whether this may have differed from hospital-acquired or facility-acquired UTIs. Another limitation was the relatively short time frame for data collection. A data collection period greater than 91 days would allow for a larger sample size, thus making the data more robust and potentially allowing for the identification of other trends not seen in the current study. A longer data collection period also would have afforded the opportunity to track more robust clinical outcomes throughout the study, identifying whether treatment failure may have been linked to the use of certain classes or spectrums of activity of antibiotics.
Conclusion
Despite the E coli resistance rate to ciprofloxacin (> 20%), the empiric treatments chosen were > 85% effective, needing minimal follow-up once a patient left the ED. Nonetheless, a change in prescribing patterns based on recent national recommendations may provide expanded opportunities in antimicrobial stewardship for ED-based pharmacists. Further research is needed in antimicrobial stewardship within this facility’s outpatient primary care realm, potentially uncovering other opportunities for pharmacist intervention to assure guideline concordant care for the treatment of UTIs as well as other infections treated in primary care patients.