184. The Effectiveness of a Stewardship Intervention to Improve Management of Urinary Tract Infections
Session: Poster Abstract Session: Antibiotic Stewardship
Friday, October 21, 2011
Room: Poster Hall B1
Background: Urinary tract infections (UTIs) are one of the most common infections in healthcare.  There are limited data on the effectiveness of interventions to improve diagnosis and treatment of UTIs.

Methods: We conducted a before-and-after intervention study in a 650 bed university-affiliated hospital. For randomly selected inpatients that had urine cultures collected, we evaluated the appropriateness of lab testing, antibiotic therapy and catheter use for 1 month before and 1 month after an intervention that included audit and feedback to providers. 

Results: Seventy five patients were evaluated during the baseline period and 52 during the intervention period.  There were no significant differences in the patient characteristics for the two time periods. As shown in the table, appropriate UTI antibiotic management improved significantly during the intervention. There were trends toward decreased duration of antibiotic therapy for UTI, fluoroquinolone days of therapy for UTI, and reduced inappropriate urinary catheter days. There was no improvement in appropriateness of lab testing; however, no feedback was provided in the Emergency Department where 31% of lab testing was ordered. 

 

Baseline

July 2010

Intervention

Aug 2010

P value

Appropriate lab testing

31/75 (41%)

18/52 (35%)

0.4

Appropriate UTI antibiotic management

33/75 (44%)

31/52 (61%)

0.003

Average UTI DOT per patient

6.07

3.42

0.08

Average UTI FQ DOT per patient

2.16

.94

0.13

Average inappropriate catheter days per catheterized patient

2.76

1.10

0.11

Conclusion: An intervention utilizing audit and feedback to healthcare providers was associated with a significant improvement in appropriate UTI antibiotic management, along with a trend toward decreased antibiotic days of therapy and urinary catheter use.   There was no change in inappropriate UTI lab testing.  Further studies are needed to evaluate the long-term effectiveness of such interventions and to optimize lab testing through interventions in the emergency department and in the electronic medical record system.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Jessica Jones, MD1, Donald M. Dumford, MD2, Sweta Chaudhary, MD3, Curtis J. Donskey, MD2 and Michelle T. Hecker, MD3, (1)University Hospitals of Cleveland, Cleveland, OH, (2)Louis Stokes VA Medical Center, Cleveland, OH, (3)MetroHealth Medical Center, Cleveland, OH

Disclosures:

J. Jones, None

D. M. Dumford, None

S. Chaudhary, None

C. J. Donskey, Optimer: Consultant, Research support
Merck: Consultant, Research support
ViroPharma: Consultant, Research support
OrthoMcNeil: Consultant, Research support
GoJo: Consultant, Research support

M. T. Hecker, None

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