158. Evaluating the need for Antimicrobial Stewardship Efforts in the Outpatient Setting: A Focus on Appropriate Prescribing for Urinary Tract Infections
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
  • LibertyOutptStewardship_IDWeekPoster_Draft9-11.pdf (244.7 kB)
  • Background: Increasing antimicrobial resistance is a major threat to public health.  Antimicrobial stewardship programs (ASPs) have shown to reduce antimicrobial utilization and resistance, improve patient outcomes, and decrease healthcare-associated infections.  Most ASPs target antimicrobial use in the acute care setting, however, the bulk of antimicrobial prescribing occurs at ambulatory care sites making these a critical target for ASPs.  We describe a baseline needs assessment for antimicrobial stewardship efforts focused on appropriate diagnosis and prescribing for urinary tract infections (UTIs) at ambulatory care sites.

    Methods: A retrospective cohort study was conducted of adult patients treated at three ambulatory care sites providing express care between January 1 and September 30, 2014 to assess guideline-concordant prescribing (GCP) of empiric therapy for UTIs.  Patients were eligible for inclusion if they had a diagnosis of dysuria, pyuria, cystitis, pyelonephritis or asymptomatic bacteriuria.  Patients were excluded if they were pregnant, neutropenic, or had a history of renal transplant.  Data collected included patient and diagnostic characteristics, appropriateness of therapy, and patient outcomes including office revisits within 30 days and adverse effects. Therapy was considered GCP if it met national and local health system guidelines for empiric therapy based on drug selection, dose, and duration of therapy.   

    Results: A total of 1838 patients were eligible for the study; 388 patients were randomly selected for inclusion.  Patients were mostly female (91.2%) with an average age of 50 ± 18 years.  376 patients (96.9%) had a dipstick urinalysis performed in the outpatient office while 249 (64.2%) had a urine culture performed.  Escherichia coliwas the most commonly identified organism, n = 109 (43.7%), while 95 patients (38.1%) had a negative culture.  294 (75.8%) patients received antimicrobial therapy. Ciprofloxacin was the most commonly prescribed antibiotic (33.3%), followed by sulfamethoxazole/trimethoprim (29.4%), and nitrofurantoin (12.9%).  Total GCP was achieved in only 28.6% (n = 111) of cases with only 31% of patient receiving the most appropriate drug.   

    Conclusion: This study supports the need for outpatient ASP interventions targeting appropriate UTI diagnosis and prescribing.

    Liberty Dykehouse, MSN, RN, ACNS-BC, CIC, Infection Control, Mercy Health Saint Mary's, Grand Rapids, MI, Lisa Dumkow, PharmD, BCPS, Pharmaceutical Services, Mercy Health Saint Mary's, Grand Rapids, MI and Andrew Jameson, MD, Infectious Diseases, Mercy Health Saint Mary's, Grand Rapids, MI


    L. Dykehouse, None

    L. Dumkow, None

    A. Jameson, None

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