Introduction Abnormal urinalysis (UA) results, such as pyuria or bacteriuria, increase the risk for antibiotic treatment even in the absence of urinary symptoms. In the emergency department (ED), patients presenting with psychiatric emergencies commonly undergo a medical assessment which includes a UA. We hypothesized that the rate of inappropriate antibiotic treatment for asymptomatic pyuria in the psychiatric medical population would decrease following implementation of an antimicrobial stewardship program (ASP) in the ED. Methods This retrospective cohort study compared the treatment of adult patients presenting to the ED for medical assessment during a psychiatric emergency with noted pyuria between three time periods following implementation of an ASP: early ASP (2014), established ASP (2016), and mature ASP (2018). The ASP provided education and routine audit‐and‐feedback focused on reducing urine testing and eliminating treatment of asymptomatic pyuria. The primary end point was to compare rates of inappropriate treatment of asymptomatic pyuria between groups. Secondary end points included comparing appropriate agent selection and duration for patients who were prescribed antibiotics, prescriber documentation, and patient outcomes between groups. Results A total of 180 patients with pyuria were included; 60 within each study group with 88.3% being asymptomatic. Inappropriate prescribing of antibiotics for asymptomatic patients at ED discharge decreased over time following ASP implementation (2014 = 40.4%, 2016 = 31.4%, 2018 = 17.6%; P = .036). Additionally, documentation noting a positive UA requiring antibiotic treatment decreased (2014 = 46.7%, 2016 = 40%, 2018 = 26.7%). Of the 62 patients treated with antibiotics, selection of a first‐line agent increased with ASP maturity (2014 = 15.4%, 2016 = 26.1%, 2018 = 69.9%; P = .002). Conclusion Inappropriate treatment of asymptomatic pyuria in patients presenting to the ED with psychiatric emergencies decreased significantly over time following implementation of an ASP. EDs may benefit from ASP interventions aimed at decreasing reliance on UA interpretation in this patient population.
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