Emergency medicine, a specialty developed in the United States in the 1960s, has become a crucial element of modern healthcare systems worldwide. Serving as the bridge between the community and the hospital, the emergency department is the initial point of patient and disease presentation. Often with a blank slate, it is here that the details and story are first pieced together, and the diagnosis is gradually revealed. According to Braeden Conlan, Emergency Medicine/Critical Care Physician Assistant and Medical Advisor at bioMérieux, because of this environment, “emergency clinicians are required to be generalists – trained and prepared to rapidly assess, differentiate, diagnose, and manage every conceivable condition.”

The introduction of an infectious disease in the emergency setting adds a layer of complexity, one that requires accelerated response and effective surveillance, particularly if resistance to available treatment has been reported. While the exact number of emergency cases related to infectious disease varies greatly depending on the disease, global region, and time period—in the U.S. alone, it was estimated that approximately 3.8 million emergency visits were related to infectious and parasitic diseases in 2021³.

Given the volume of encounters and the global rise of AMR, the need for antimicrobial stewardship (AMS) initiatives in the emergency department is increasingly apparent. In simple terms, AMS can be defined as collaborative efforts aimed at providing the right antibiotic to the right patient, at the righ times⁴. However, in the fast-paced and often information-limited emergency setting, this expectation is particularly challenging if rapid and effective diagnostic tests are not available. “Without knowing the infectious source, organism(s), or sensitivities, emergency clinicians are often required to start broad-spectrum empiric antibiotics to ensure adequate coverage,” says Conlan. “Indeed, aggressive regimens are often viewed as the better alternative to insufficiencies given the potential implications related to patient outcomes.”

Therefore, the pathway towards improving AMS and optimizing patient therapy is inextricably linked to diagnostic stewardship, a concept best defined as the ability to streamline treatment by ordering appropriate tests that provide rapid and accurate results. “In a setting fraught with clinical ambiguity, the addition of delayed results or diagnostic uncertainty can set the stage for inappropriate antibiotic use,” Conlan points out. It is, therefore, imperative to provide access to better diagnostics and actionable data to help guide clinicians in making informed clinical decisions earlier in the patient care pathway.

Thankfully there have been significant advances in diagnostic testing and data-driven technologies over the last decade. Coupled with stewardship programs, these innovative solutions are making a difference in the increasingly overburdened emergency departments that have high patient turnover and significant time constraints. Studies have shown these measures can help optimize antimicrobial therapy and directly impact patient outcomes⁶. With these and continuing developments, antimicrobial stewardship in the emergency department is more attainable than ever before. Conlan notes, “This is an exciting time in emergency medicine, with advances in testing and activation of stewardship initiatives that support a more personalized and precision approach to medicine.”