992. Antimicrobial Stewardship for Catheter-Associated Urinary Tract Infections:  Early Impact of Guideline Implementation
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDweek_poster_CA-UTI2013_Final.pdf (178.3 kB)
  • Background:

    Institution specific urinary tract infection (UTI) guidelines were implemented in July 2011.  Our guidelines recommend cefepime (CEF) for empiric treatment of symptomatic catheter-associated UTI (CA-UTI) based on local susceptibility patterns. The purpose of this study was to evaluate initial antibiotic therapy for CA-UTI after guideline implementation.

    Methods:

    A retrospective chart review of patients with CA-UTI, between 9/1/2010-7/1/2011 (before guideline implementation; BGI) and 9/1/2011-7/1/2012 (after guideline implementation; AGI) was conducted.  Initial antibiotic therapy; clinical outcomes; and percentage of those who received appropriate empiric therapy based on in-vitro activity were evaluated.

    Results:

    Overall, 84 patients with CA-UTI were included (54 BGI and 30 AGI). Duration of urinary catheter prior to positive culture was 6 days in both groups.  Escherichia coli (37% vs. 23%, p=NS), Enterococcus species (19% vs. 29%, p=NS), and Pseudomonas aeruginosa (12% vs. 26%, p=NS) were the most common pathogens.  Sixteen (30%) patients BGI and 6 (20%) patients AGI had a polymicrobial urine culture (p=NS).  Vancomycin (35% vs. 17%, p=NS), ciprofloxacin [CIP] (30% vs. 17%, p=NS), and piperacillin-tazobactam (17% vs. 23%, p=NS) were the most common antibiotics used for initial therapy.  Only 21 (39%) patients BGI and 12 (40%) patients AGI had a CA-UTI without a concurrent infection.  CIP use was still high (48% vs. 25%, p=NS) and CEF use was still low (10% vs. 8%, p=NS) in these patients.  Resistance to CIP was 38%, while resistance to CEF was only 9% among all urinary Gram-negative isolates.  Thirteen (24%) patients BGI and 7 (23%) patients AGI received empiric therapy consistent with our guidelines (p=NS).  However, 49 (91%) patients BGI and 26 (87%) patients AGI received appropriate initial therapy based on in-vitro activity.  Clinical success was similar in both groups (89% vs. 87%, p=NS).

    Conclusion:

    There was no change in initial antibiotic selection after guideline implementation.  Despite low compliance with our guidelines, most regimens provided adequate coverage based on in-vitro susceptibilities.  CIP should not be used as initial therapy due to high resistance.  Additional stewardship measures such as education and coordinated ordersets are needed to promote greater guideline adherence.

    Christine Ciaramella, PharmD1, Marco Scipione, PharmD1, Yanina Dubrovskaya, PharmD1, Donald Chen, MD2, Steven Bock, RN3, John Papadopoulos, PharmD1 and Sapna Mehta, MD4, (1)Department of Pharmacy, NYU Langone Medical Center, New York, NY, (2)Infection Prevention and Control, NYU Langone Medical Center, New York, NY, (3)Infection Prevention and Control, New York University Langone Medical Center, New York, NY, (4)Infectious Diseases, New York University School of Medicine, New York, NY

    Disclosures:

    C. Ciaramella, None

    M. Scipione, None

    Y. Dubrovskaya, None

    D. Chen, None

    S. Bock, None

    J. Papadopoulos, None

    S. Mehta, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.