Program Schedule

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Retrospective, multicenter, point prevalence study of urinary tract infection (UTI) data for a city-wide antimicrobial stewardship initiative

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • IDWeek Poster v2.0.pdf (467.5 kB)
  • Background: Antimicrobial stewardship optimizes patient care via promoting appropriate antimicrobial use. Institutional data demonstrates UTI as the most common indication for antimicrobial initiation, but diagnosis remains challenging and treatment of asymptomatic bacteriuria is common. The purpose of this study was to evaluate antimicrobial prescribing practices for UTIs in the acute care setting using a standardized chart audit tool as part of an antimicrobial stewardship initiative.

    Methods: Four hospitals participated in this retrospective, multicenter, point prevalence survey using a standardized CDC-endorsed chart audit tool. Data were captured on a single day at each hospital in January or February 2014. Patients were included if they were receiving antimicrobial(s) for an indication of UTI per order indication or if not available, through positive urine culture (1 hospital). Data collected included demographics, presenting symptoms, urinalysis and urine culture, empiric and pathogen-guided treatment and total inpatient duration of therapy.

    Results: Of 91 patients included, 59 (65%) were female. Hospital medicine service was the primary team for 61 (67%). Eighteen (20%) patients were asymptomatic and 29 (32%) presented with only one UTI related symptom. Commonly reported signs and symptoms included leukocytosis (27%), fever or rigors (23%) and new onset delirium (19%). Urine culture was obtained in 83 patients; Gram negative organisms (64%) were the most common pathogens. After applying McGeer Criteria to 66 patients without an indwelling urinary catheter, only 7 (11%) met both symptomatic and microbiological criteria for UTI. Ceftriaxone, ciprofloxacin and sulfamethoxazole-trimethoprim were the most commonly used antimicrobials for monotherapy. The median duration of therapy for those patients meeting McGeer Criteria was five days.

    Conclusion: These results demonstrate an over-use of antimicrobials for UTI in the absence of diagnostic criteria. Using a standardized, CDC-endorsed chart audit tool facilitated rapid project implementation and led to timely identification of a stewardship intervention targeting appropriate diagnostics that could be implemented across a multi-institution collaborative.

    Chas Hoffmann, PharmD1, Emily Sydnor, MD, MHS2, Mary Lourdes Brundige, PharmD3, Shashi Patel, PharmD4, Christopher Evans, PharmD1, Elizabeth Rightmier, PharmD5, Mary Staicu, PharmD3, Christina Felsen, MPH6, Elizabeth Dodds Ashley, PharmD, MHS1 and Ghinwa Dumyati, MD1, (1)University of Rochester Medical Center, Rochester, NY, (2)University of Utah School of Medicine, Salt Lake City, UT, (3)Rochester General Hospital, Rochester, NY, (4)Unity Health, Rochester, NY, (5)Highland Hospital, Rochester, NY, (6)New York Rochester Emerging Infections Program at the University of Rochester Medical Center, Center for Community Health, Rochester, NY

    Disclosures:

    C. Hoffmann, None

    E. Sydnor, None

    M. L. Brundige, None

    S. Patel, None

    C. Evans, None

    E. Rightmier, None

    M. Staicu, None

    C. Felsen, None

    E. Dodds Ashley, None

    G. Dumyati, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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