scholarly journals Implementation of Diagnostic Stewardship Algorithms by Bedside Nurses to Improve Culturing Practices: Factors Associated With Success

2020 ◽  
Vol 41 (S1) ◽  
pp. s276-s277
Author(s):  
Valeria Fabre ◽  
Alejandra Salinas ◽  
Ashley Pleiss ◽  
Elizabeth Zink ◽  
George Jones ◽  
...  
Keyword(s):  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Open Unit ◽  
Johns Hopkins Hospital ◽  
Statistical Process ◽  
Stewardship Program ◽  
Before And After ◽  
Assess Treatment Response ◽  
Tract Infections ◽  
Physician Support

Background: Bedside nurses have been recognized as potential antibiotic stewards; however, data on effective ways that nurses can contribute to stewardship activities in acute-care hospitals are scarce. Methods: A nurse-driven urine culture intervention to improve urine culture ordering practices was implemented in a medicine and a neurocritical care unit (NCCU) at The Johns Hopkins Hospital. Bedside nurses implemented an algorithm (Fig. 1) developed by the antibiotic stewardship program (ASP) to review the appropriateness of urine culture and to guide discussions with ordering providers regarding unnecessary urine cultures. Nurses received in-person training by an ASP physician champion on how to use the algorithm and education on the definition and indications for evaluation for asymptomatic bacteriuria and urinary tract infections. The ASP physician periodically visited the units to address concerns and questions. In both units, a nurse champion was identified to serve as liaison between the ASP and bedside nurses, and physician support was obtained before the intervention. The pre- and postintervention periods for the medicine unit were September 2017–August 2018 and September 2018–August 2019, respectively. For the NCCU, these periods were September 2018–February 2019 and March 2019–September 2019, respectively. Trends in urine cultures per 100 patient days (PD) were examined with statistical process charts and compared before and after the intervention using a standard incident ratio (IRR) and Poisson regression. Results: In total, 327 urine cultures were collected in the medicine unit and 293 in the NCCU over the study period. Although the intervention led to a significant 34% reduction in the rate of urine cultures on the medicine unit (from 2.3 to 1.5 cultures/100 PD; IRR, 0.66; 95% CI, 0.50–0.87; P < .01), the number of urine cultures remained without a significant change in the NCCU (from 4.5 to 3.7 cultures/100 PD; IRR, 0.89; 95% CI, 0.65–1.22; P = .48) (Fig. 2). Conclusions: Algorithm-based, nurse-driven review of urine culture indications reduced urine cultures on a medicine unit but not in a neurosciences ICU. Success on the medicine unit may have been driven by highly engaged nurse and physician champions and by patients being able to respond questions about symptoms. The following factors might have impacted results on NCCU: presence of conflicting protocols (eg, panculturing patients every 48 hours per a hypothermia protocol), unit tradition (eg, obtaining cultures to assess treatment response), perception of greater risk benefit in NCCU patients, and unit dynamics (open unit with other primary services placing orders for patients). Unit and team dynamics can affect effective implementation of antimicrobial stewardship interventions by nurses.Funding: NoneDisclosures: None

scholarly journals Evaluation of Asymptomatic Bacteruria Management Before and After Antimicrobial Stewardship Program Implementation: Retrospective Study

2021 ◽  
Author(s):  
Ahlam Alghamdi ◽  
Majed Almajed ◽  
Raneem Alalawi ◽  
Amjad Alganame ◽  
Shorooq Alanazi ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Program Implementation ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Antimicrobial Stewardship Program ◽  
Positive Urine Culture ◽  
Inappropriate Use ◽  
Stewardship Program ◽  
Positive Urine ◽  
Before And After

Abstract BackgroundThe Infectious Diseases Society of America (IDSA) recommends against screening for and/or treating asymptomatic bacteriuria (ASB). This study aims to evaluate the inappropriate use of antibiotics in ASB before and after Antimicrobial Stewardship Program implementation and advance towards its appropriate use. MethodWe performed a retrospective study of patients diagnosed with ASB from 2016 to 2019 at a tertiary hospital in Saudi Arabia. This study included hospitalized patients ≥18 years old who had a positive urine culture with no signs or symptoms of urinary tract infection and were on antibiotics for asymptomatic bacteriuria. We excluded pregnant women, solid organ transplant patients, patient on active chemotherapy, and patients about to undergo urological surgery.ResultsA total of 716 patients with a positive urine culture were screened . Among these, we identified 109 patients with ASB who were enrolled in our study. The rate of inappropriate antibiotic use was 95% during the study period. The implementation of the Antimicrobial Stewardship Program was associated with a significant reduction in the use of carbapenems (P = 0.04) and an increase in the use of cephalosporins (P = .099687). However, overprescribing antimicrobial agents was a concern in both eras. Approximately 90% of the microorganisms identified were gram-negative bacteria. Of those, 38.7% were multidrug-resistant strains. ConclusionThe urine culture order in ASB is considered relatively small number; however, it showed a high rate of the inappropriate use of antibiotics when there is an order of urine culture in both era. ASP ought to focus on targeting the ordering physician, promoting awareness and/or organizational interventions that appear to reduce the incidence of overtreatment.

scholarly journals 2084. Implementation of a Diagnostic Stewardship Algorithm by Bedside Nurses to Reduce Unnecessary Urinary Cultures in Hospitalized Adult Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S703-S704
Author(s):  
Valeria Fabre ◽  
Ashley Pleiss ◽  
Zoe Demko ◽  
Anna Sick-Samuels ◽  
Lauri Hicks ◽  
...  
Keyword(s):  
Asymptomatic Bacteriuria ◽  
Control Unit ◽  
Johns Hopkins Hospital ◽  
Post Intervention ◽  
Statistical Process ◽  
Team Members ◽  
Before And After ◽  
Algorithm Implementation ◽  
The Impact ◽  
Intervention Unit

Abstract Background Urine cultures (UCx) are often ordered in patients without symptoms of urinary tract infection. A pilot study was conducted to assess the impact of a nurse-driven UCx diagnostic stewardship intervention for adult inpatients. Methods We interviewed eight nurses to determine the feasibility of a nurse-driven UCx stewardship intervention. Based on their feedback, an algorithm with appropriate indications for UCx was developed (Figure 1) and approved by physicians and nurses for piloting on a 24-bed medicine unit at The Johns Hopkins Hospital. UCx orders/100 patient-days (PD) were trended with statistical process charts in the intervention and a control unit. Nurses used the algorithm to guide discussions with ordering providers and to suggest instances where UCx may be unnecessary (“intervention”). Nurses were educated on an antibiotic (abx) use safety and appropriate testing during live sessions prior to algorithm implementation. Two study team members reviewed all UCx ordered in the intervention unit 12 months before and 6 months after the intervention for appropriateness based on algorithm criteria. Feedback on UCx order appropriateness and case-based discussion were provided to nurses via in-person meetings post intervention. Data were compared using the χ 2 or the Mann–Whitney test as appropriate. The rate of UCx orders before and after the intervention were compared using a standard incident ratio (IRR). Results With algorithm implementation, the mean rate of UCx orders/100 PD decreased from 2.7 to 1.8 (39% decrease) in the intervention unit (IRR 0.61, 95% confidence intervals (CI) 0.45–0.82, P = .16). Mean UCx order rates in the control unit were 2.49 and 2.99, respectively (Figure 2). Characteristics of patients reviewed for appropriateness were similar between the two study periods: median age 63 (IQR 39, 74) vs. 56 (IQR 45, 76), female sex 65% vs. 61%, on hemodialysis 7% vs. 11%, urinary catheter present 20% vs. 29%. The proportion of inappropriate UCx decreased from 59% (98/165) to 50% (32/64) (P = 0.16). There were 8 and 1 cases of asymptomatic bacteriuria inappropriately treated in the pre- and post-intervention periods, respectively (42 and 7 abx days). Conclusion With the appropriate training and tools, nurses can steward UCx and reduce unnecessary testing and abx use Disclosures Sara E. Cosgrove, MD, MS, Basilea: Consultant; Theravance: Consultant.

Impact of an Antimicrobial Stewardship Care Bundle to Improve the Management of Patients with Suspected or Confirmed Urinary Tract Infection

2016 ◽  
Vol 37 (12) ◽  
pp. 1499-1501 ◽  
Author(s):  
Curtis D. Collins ◽  
Jared J. Kabara ◽  
Sarah M. Michienzi ◽  
Anurag N. Malani
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Stewardship ◽  
Asymptomatic Bacteriuria ◽  
Care Bundle ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Bundle Compliance ◽  
Tract Infections

Implementation of an antimicrobial stewardship program bundle for urinary tract infections among 92 patients led to a higher rate of discontinuation of therapy for asymptomatic bacteriuria (52.4% vs 12.5%; P =.004), more appropriate durations of therapy (88.7% vs 63.6%; P =.001), and significantly higher overall bundle compliance (75% vs 38.2%; P < .001).Infect Control Hosp Epidemiol 2016;1499–1501

LO91: Urinary tract infections in the paediatric emergency department: A quality improvement initiative to promote diagnostic and antimicrobial stewardship

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S41
Author(s):  
V. Singh ◽  
L. Morrissey ◽  
M. Science ◽  
O. Ostrow
Keyword(s):  
Emergency Department ◽  
Urinary Tract ◽  
Antimicrobial Stewardship ◽  
Urine Culture ◽  
Diagnostic Algorithm ◽  
Antimicrobial Treatment ◽  
Stewardship Program ◽  
Common Diagnosis ◽  
Negative Urine Culture ◽  
Tract Infections

Background: Urinary tract infection (UTI) is a common diagnosis in children presenting to the Emergency Department (ED) and often leads to empiric antibiotic treatment prior to culture results. A recent study at our centre found that 47% of children diagnosed with a UTI and discharged on antibiotics had a negative urine culture. None of these patients were notified of the negative result or to discontinue antimicrobial treatment. Aim Statement: The aim of this study was to improve UTI diagnostic accuracy by 50% while promoting antimicrobial stewardship through timely antibiotic discontinuation and standardized antimicrobial treatment for uncomplicated UTIs over the next 12 months. Measures &amp; Design: Three interventions were developed using plan-do-study-act (PDSA) cycles. In collaboration with the hospital's Choosing Wisely campaign and antimicrobial stewardship program, an evidence-based empiric UTI diagnostic algorithm was created to aid with diagnostic decision-making and reduce practice variation. A daily call-back system was also implemented for urine cultures where patients who had a negative urine culture were contacted to stop antibiotics. Lastly, a practice alert was integrated in the EMR as a reminder of appropriate antimicrobial prescription duration. The main outcome measures were the percentage of inappropriately diagnosed UTIs and percentage with timely antimicrobial discontinuation. Process measures included antibiotic days saved, treatment duration, and physician adherence to the algorithm. As a balancing measure, positive urine cultures were reviewed to assess accuracy of the algorithm to detect UTIs and potential harm from delayed UTI diagnoses. Evaluation/Results: Early results from the 530 children included in the analysis demonstrated a 14% reduction in inappropriate UTI diagnoses. With the initiation of the call-back system, the antibiotic days saved increased from 0 to 495 days. Call-backs for negative cultures increased from 0% to 68% of the time. Of those positive cultures with a missed UTI diagnosis, only 5 patients in 5 months had a return visit within 72 hours and none required admission. Discussion/Impact: Appropriate diagnosis and treatment of UTIs in our ED has improved with the implementation of a diagnostic algorithm. A larger impact is anticipated once the algorithm is embedded in the EMR as a form of decision support, but these changes take time to implement. Although labour intensive, the call-back system has greatly impacted the antimicrobial days saved and reduced risk for harm in this population.

scholarly journals Sustained decrease in urine culture utilization after implementing a reflex urine culture intervention: A multicenter quasi-experimental study

2020 ◽  
Vol 41 (3) ◽  
pp. 369-371 ◽  
Author(s):  
Jessica R. Howard-Anderson ◽  
Shanza Ashraf ◽  
Elizabeth C. Overton ◽  
Lisa Reif ◽  
David J. Murphy ◽  
...  
Keyword(s):  
Experimental Study ◽  
Urinary Tract ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Diagnostic Efficiency ◽  
Urinary Catheters ◽  
Laboratory Findings ◽  
Quasi Experimental ◽  
Tract Infections ◽  
The Impact

Accurately diagnosing urinary tract infections (UTIs) in hospitalized patients remains challenging, requiring correlation of frequently nonspecific symptoms and laboratory findings. Urine cultures (UCs) are often ordered indiscriminately, especially in patients with urinary catheters, despite the Infectious Diseases Society of America guidelines recommending against routine screening for asymptomatic bacteriuria (ASB).1,2 Positive UCs can be difficult for providers to ignore, leading to unnecessary antibiotic treatment of ASB.2,3 Using diagnostic stewardship to limit UCs to situations with a positive urinalysis (UA) can reduce inappropriate UCs since the absence of pyuria suggests the absence of infection.4–6 We assessed the impact of the implementation of a UA with reflex to UC algorithm (“reflex intervention”) on UC ordering practices, diagnostic efficiency, and UTIs using a quasi-experimental design.

scholarly journals Are Urinalyses Used Inappropriately in the Diagnosis of Urinary Tract Infections?

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S350-S350 ◽  
Author(s):  
Ghada Elshimy ◽  
Vincent Mariano ◽  
Christina Mariyam Joy ◽  
Parminder Kaur ◽  
Monisha Singhal
Keyword(s):  
Urinary Tract ◽  
Antibiotic Treatment ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
White Blood Cells ◽  
Asymptomatic Bacteriuria ◽  
Further Education ◽  
Positive Urine ◽  
Tract Infections ◽  
Hospital Wards

Abstract Background One of the most readily available and cost effective tests in the diagnosis of urinary tract infections (UTI) is the urinalysis. Problems arise when antibiotic treatment is initiated in a patient who does not display typical signs and symptoms of UTI and for whom a urinalysis was obtained for other reasons. Methods This was a retrospective observational study carried out on 1000 patients with positive urine nitrite. Medical records were identified with subsequent analysis of urine culture and symptomatology. Recorded and analyzed data included: age, sex, location (emergency room (ER) or hospital ward), findings on urinalysis (pH, presence of leukocyte esterase(LE), epithelial cells, bacteria, and white blood cells (WBCs)) and antibiotic treatment. Results Of these 1000 patients with positive nitrite, we excluded 815 patients (81 had missing data, 466 met exclusion criteria and 268 had symptomatic UTI). 185 were found to not have any symptoms of a UTI. Inappropriate antibiotic treatment occurred in 108/185 patients (58.4%) and was significantly associated with greater amounts of bacteria and WBCs in the urinalyses (P = 0.008 and P = 0.029, respectively). It was also significantly more likely to occur in the ER than the hospital wards (92/147 treated in the ER vs. 16/37 treated on the hospital wards, P = 0.033). There was no significant association between antibiotic treatment and age, sex, urine pH, urine LE, and urine epithelial cell amounts (P &gt; 0.05). Urine cultures were not obtained in 69.7% of patients. A positive urine culture was significantly associated with inappropriate antibiotic treatment (P = 0.0006). The two most common presenting complaints were psychiatric complaints (21.6%) and vaginal bleeding (14.6%). Conclusion Urinalysis can be an invaluable diagnostic tool, but must be used and interpreted appropriately. There is a misperception that pyuria with bacteriuria defines UTI. However, positive results on a urinalysis alone in an asymptomatic patient is not enough to diagnose a UTI, and antibiotic treatment is only indicated in specific circumstances as outlined by IDSA guidelines for the treatment of asymptomatic bacteriuria. Further education targeting appropriate interpretation of urinalyses and IDSA guidelines is needed to decrease the unnecessary use of antibiotics. Disclosures All authors: No reported disclosures.

scholarly journals 3 UTI Diagnosis and Management in the Over 65s According to Public Health England Guidelines

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
H G T Brice ◽  
N Doherty ◽  
C Biss ◽  
T Quigley
Keyword(s):  
Public Health ◽  
Cell Count ◽  
Educational Intervention ◽  
Guideline Adherence ◽  
Urine Culture ◽  
White Cell Count ◽  
Asymptomatic Bacteriuria ◽  
White Cell ◽  
Urine Samples ◽  
Tract Infections

Abstract Introduction The diagnosis of urinary tract infections (UTI) becomes increasingly difficult with age. Dipsticks are unreliable and with the prevalence of asymptomatic bacteriuria increasing to 17% in females over 75 even urine culture results can be unreliable. Public Health England (PHE) released new guidelines in November 2018 with criteria for diagnosing UTIs in the over 65s. Methods Identify patients over 65 who are diagnosed with a UTI in Solihull acute medical unit. Collect data on presenting symptoms, dipstick and culture results and antibiotic use. Aim to improve guideline adherence and decrease dipstick use through education of medical and nursing staff via presentations and posters. Results Prior to the educational intervention guideline adherence when diagnosing UTIs in over 65s was 55%. This rose to 82% following the educational intervention. Dipstick usage decreased from 49% to 28% following the intervention. Dipsticks were shown to be unreliable as 21.6% of dipstick positive urine samples sent for culture had a normal (0-80) white cell count in the laboratory, whilst 43.8% of dipstick negative urine samples sent for culture had a raised white cell count in the laboratory. On retrospective analysis 16.1% of patients treated for a UTI appeared to have had an asymptomatic bacteriuria. Co-amoxiclav was initially used for 51% of patients however there was resistance to Co-amoxiclav in 31% of samples where an organism was cultured. Conclusions The educational intervention was able to increase PHE guideline adherence for diagnosing UTIs in the over 65s. There was also a decrease in the use of dipsticks which were shown to be unreliable in this age group. Prescribers remained reliant on broad-spectrum antibiotics with Co-Amoxiclav being most commonly used. This is likely to be ineffective in a significant number of patients given the common resistance seen in urine culture sensitivities.

Effect of a urine culture stewardship initiative on urine culture utilization and catheter-associated urinary tract infections in intensive care units

2021 ◽  
pp. 1-4
Author(s):  
Layla A. Al-Bizri ◽  
Amit T. Vahia ◽  
Khulood Rizvi ◽  
Ana C. Bardossy ◽  
Paula K. Robinson ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Intensive Care ◽  
Urinary Tract ◽  
Intensive Care Units ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Series Data ◽  
Study Cohort ◽  
Stewardship Program ◽  
Tract Infections

Abstract Objective: Urine cultures have poor specificity for catheter-associated urinary tract infections (CAUTIs). We evaluated the effect of a urine-culture stewardship program on urine culture utilization and CAUTI in adult intensive care units (ICUs). Design: A quasi-interventional study was performed from 2015 to 2017. Setting and patients: The study cohort comprised 21,367 patients admitted to the ICU at a teaching hospital. Intervention: The urine culture stewardship program included monthly 1-hour discussions with ICU house staff emphasizing avoidance of “pan-culture” for sepsis workup and obtaining urine culture only if a urinary source of sepsis is suspected. The urine culture utilization rate metric (UCUR; ie, no. urine cultueres/catheter days ×100) was utilized to measure the effect. Monthly UCUR, catheter utilization ratio (CUR), and CAUTI rate were reported on an interactive quality dashboard. To ensure safety, catheterized ICU patients (2015–2016) were evaluated for 30-day readmission for UTI. Time-series data and relationships were analyzed using Spearman correlation coefficients and regression analysis. Results: Urine culture utilization decreased from 3,081 in 2015 to 2,158 in 2016 to 1,218 in 2017. CAUTIs decreased from 78 in 2015 to 60 in 2016 and 28 in 2017. Regression analysis over time showed significant decreases in UCUR (r, 0.917; P < .0001) and CAUTI rate (r, 0.657; P < .0001). The co-correlation between UCUR and CAUTI rate was (r, 0.625; P < .0001) compared to CUR and CAUTI rate (r, 0.523; P = .004). None of these patients was readmitted with a CAUTI. Conclusions: Urine culture stewardship program was effective and safe in reducing UC overutilization and was correlated with a decrease in CAUTIs. Addition of urine-culture stewardship to standard best practices could reduce CAUTI in ICUs.

scholarly journals Significant bacteriuria among requested repeat urine samples and its clinical correlation

2021 ◽  
Author(s):  
Arjun Bhugra ◽  
Supriya Gachinmath
Keyword(s):  
Escherichia Coli ◽  
Bacterial Infections ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Urine Samples ◽  
Clinical Correlation ◽  
Normal Flora ◽  
Sensitivity Pattern ◽  
Significant Bacteriuria ◽  
Tract Infections

Background and Objectives: Urinary tract infections (UTI) are the most common bacterial infections in both outpatient and inpatient department received for routine bacterial culture and sensitivity. We looked for significant bacteriuria in re- quested repeat urine sample after primary urine culture yielded significant growth (>105  CFU/ml) of ≥3 types of colonies. Also studied, different isolates grown with their sensitivity pattern and contamination rates of urine samples from different departments. Materials and Methods: In routine, primary urine cultures yielding ≥3 types of colonies on Cystine Lactose Electrolyte Deficient (C.L.E.D) were requested for repeat samples, collected with aseptic precautions after proper instructions. Data was analyzed for the Microbiological profile and its clinical correlation. Results: Among 617 received requested urine samples, 292 (47.3%) yielded significant bacteriuria. Clinical details were available for 252 cases out of which 100 (39.7%) showed asymptomatic bacteriuria, 87 (34.5%) complicated UTI and 65 (25.7%) uncomplicated UTI. Null hypothesis was rejected as 292 (47.3%) of the received repeat samples showed significant bacteriuria and 325 (53%) showed normal flora/no growth i.e. there is a 50% chance of getting either a positive culture or normal flora/no growth in repeat urine samples after the primary urine culture showed ≥3 types of colonies. It indicates the importance of requesting repeat urine samples for an accurate urine culture report. Male patients were significantly associ- ated with significant bacteriuria and complicated UTI (p= 0.001). Escherichia coli (n=112, 28%) was the most common fol- lowed by Klebsiella species (n=66, 16.4%) and Enterococcus species (n=69, 17.2%). 183 (45.6%) isolates were Multi-Drug Resistant (MDR) Gram Negative Bacilli (GNBs), Escherichia coli (50.3%) being most common. Vancomycin Resistant Enterococcus (VRE) (n=8, 2.0%) was also isolated. Conclusion: Our study justifies the rationale for asking a repeat urine samples which helps in providing an appropriate mi- crobiological report with antibiotic sensitivity pattern, hence preventing unwanted reporting of commensals/contaminants facilitating evidence based therapy.

scholarly journals 83. Impact of a Urine Culture Best Practice Advisory on Collection of Urine Cultures and Subsequent Antibiotic Therapy

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S157-S158
Author(s):  
Logan White ◽  
Andrea Dooley-Wood ◽  
Hien Nguyen ◽  
Aiman Bandali
Keyword(s):  
Antibiotic Therapy ◽  
Adverse Drug Reactions ◽  
Best Practice ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Resistant Bacteria ◽  
Drug Reactions ◽  
Practice Advisory ◽  
Tract Infections ◽  
The Impact

Abstract Background In the acute care setting, urinary tract infections (UTIs) may be over diagnosed in up to 40% of cases. In most scenarios, asymptomatic bacteriuria (ASB) is not an indication for antibiotic therapy; inappropriate therapy is associated with a higher incidence of antibiotic-resistant bacteria and adverse drug reactions. Limiting inappropriate collection of urine cultures may decrease unnecessary treatment of ASB. The objective of this study is to assess the impact of a urine culture best practice advisory (BPA) on collection of unnecessary urine cultures. Methods This retrospective, observational, single-center study included adult inpatients with an order for urinalysis/urine culture. Those who were pregnant, had a concomitant infection other than UTI and/or were taking antimicrobials for a non-UTI indication, and were undergoing urological procedures were excluded. Duplicate urine culture collections and/or admissions were excluded. Incorporation of a BPA into computerized provider order entry, allowing providers to assess need and document indication for urine culture collection, was implemented on July 2019. The following clinical outcomes were assessed: number of unnecessary urine cultures collected, number of antibiotic treatments, and antibiotic-associated adverse reactions. Results Two hundred met criteria for inclusion; 96 in the pre-BPA group (Aug – Oct 2018) and 104 in the post-BPA group (Aug – Oct 2019). Seventy-four (37%) were male and the mean age was 64 and 70 years (p=0.249), respectively. The Charlson Comorbidity Index (CCI) was similar between groups (4 vs. 5, p=0.162) and majority were admitted to a general medical ward (94.5%). Seventy patients (72.9%) in the pre-BPA group and 47 (51.6%) in the post-BPA group had inappropriately ordered urinalysis/urine cultures (OR 0.40; 95% CI 0.22-0.73; p=0.003). Of these patients, 15 (21.4%) and 9 (19.1%) from the pre- and post-BPA groups, respectively, were treated (p=0.077). Among those treated, only two adverse drug reactions were reported. Conclusion Implementation of a BPA significantly reduced the number of inappropriate urinalysis/urine culture orders. There was a trend towards decreased antibiotic use for ASB. Future studies are warranted to assess sustainability of these results. Disclosures All Authors: No reported disclosures

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