scholarly journals 48. Local Implementation of an Antibiotic Stewardship Intervention for Asymptomatic Bacteriuria Through Centralized Facilitation Required Minimal Costs and Effort

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S145-S145
Author(s):  
Suja S Rajan ◽  
Larissa Grigoryan ◽  
John Van ◽  
Paola Lichtenberger ◽  
Payal K Patel ◽  
...  
Keyword(s):  
Antibiotic Stewardship ◽  
Scale Up ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Successful Implementation ◽  
Full Time ◽  
Research Coordinator ◽  
Intervention Cost ◽  
Project Coordination

Abstract Background The cost of an antibiotic stewardship intervention is an important yet often neglected factor in antibiotic stewardship research. We studied the costs associated with successful implementation of the “Kicking CAUTI” intervention to decrease treatment of asymptomatic bacteriuria (ASB). Methods A central coordinating site facilitated roll-out of an audit and feedback intervention to decrease unnecessary urine cultures and antibiotic treatment in patients with ASB in four Veterans Affairs medical centers. Each site had a physician site champion, a part-time research coordinator, and 1-2 additional participants (often pharmacists). Participants kept weekly time-logs to collect the minutes associated with intervention tasks, and percent full-time effort (FTE) and costs were computed. For weeks with missing logs the average minutes for each activity associated with each type of professional was imputed. Salary information was obtained from the Bureau of Labor Statistics and Association of American Medical Colleges. Results Research coordinator time comprised of majority of the personnel time, followed by the physician site champions (Figure 1). Each intervention site required about 10% FTE/year of a research coordinator, and 3.5% FTE/year and 3.8% FTE/year of a physician and pharmacist respectively. The coordinating site required 37% FTE/year of a research coordinator, and 9% FTE of a physician to spearhead the intervention. Research coordinators predominantly spent their time on chart-reviews and project coordination. Physician champions predominantly spent their time on delivering audit and feedback and project coordination. The intervention cost USD 22,299/year per site on average, and USD 45,359/year for the coordinating site. Conclusion The Kicking CAUTI intervention was successful at reducing urine cultures and associated antibiotic use, with minimal time from the local team members. The research coordinators’ time was primarily spent on collection of research data, which will not be necessary outside of a research project. Our model of centralized facilitation makes economic sense for widespread scale-up and dissemination of antibiotic stewardship interventions in integrated healthcare systems. Disclosures Barbara Trautner, MD, PhD, Genentech (Consultant, Scientific Research Study Investigator)

scholarly journals Development of an Electronic Algorithm to Identify Inappropriate Antibiotic Prescribing for Pediatric Pharyngitis

2020 ◽  
Vol 41 (S1) ◽  
pp. s188-s189
Author(s):  
Jeffrey Gerber ◽  
Robert Grundmeier ◽  
Keith Hamilton ◽  
Lauri Hicks ◽  
Melinda Neuhauser ◽  
...  
Keyword(s):  
Predictive Value ◽  
Gold Standard ◽  
Antibiotic Stewardship ◽  
Chart Review ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Tract Infections ◽  
The Impact

Background: Antibiotic overuse contributes to antibiotic resistance and unnecessary adverse drug effects. Antibiotic stewardship interventions have primarily focused on acute-care settings. Most antibiotic use, however, occurs in outpatients with acute respiratory tract infections such as pharyngitis. The electronic health record (EHR) might provide an effective and efficient tool for outpatient antibiotic stewardship. We aimed to develop and validate an electronic algorithm to identify inappropriate antibiotic use for pediatric outpatients with pharyngitis. Methods: This study was conducted within the Children’s Hospital of Philadelphia (CHOP) Care Network, including 31 pediatric primary care practices and 3 urgent care centers with a shared EHR serving >250,000 children. We used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify encounters for pharyngitis at any CHOP practice from March 15, 2017, to March 14, 2018, excluding those with concurrent infections (eg, otitis media, sinusitis), immunocompromising conditions, or other comorbidities that might influence the need for antibiotics. We randomly selected 450 features for detailed chart abstraction assessing patient demographics as well as practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for evaluating the electronic algorithm. Criteria for appropriate use included streptococcal testing, use of penicillin or amoxicillin (absent β-lactam allergy), and a 10-day duration of therapy. Results: In 450 patients, the median age was 8.4 years (IQR, 5.5–9.0) and 54% were women. On chart review, 149 patients (33%) received an antibiotic, of whom 126 had a positive rapid strep result. Thus, based on chart review, 23 subjects (5%) diagnosed with pharyngitis received antibiotics inappropriately. Amoxicillin or penicillin was prescribed for 100 of the 126 children (79%) with a positive rapid strep test. Of the 126 children with a positive test, 114 (90%) received the correct antibiotic: amoxicillin, penicillin, or an appropriate alternative antibiotic due to b-lactam allergy. Duration of treatment was correct for all 126 children. Using the electronic algorithm, the proportion of inappropriate prescribing was 28 of 450 (6%). The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were sensitivity (99%, 422 of 427); specificity (100%, 23 of 23); positive predictive value (82%, 23 of 28); and negative predictive value (100%, 422 of 422). Conclusions: For children with pharyngitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. Future work should validate this approach in other settings and develop and evaluate the impact of an audit and feedback intervention based on this tool.Funding: NoneDisclosures: None

scholarly journals 172. Inpatient Antibiotic Prescribing Patterns Using the WHO Access Watch and Reserve (AWaRe) Classification in Okinawa, Japan: A Point Prevalence Survey

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S195-S196
Author(s):  
Payal K Patel ◽  
Naoyuki Satoh ◽  
Masashi Narita ◽  
Yoshiaki Cho ◽  
Yusuke Oshiro ◽  
...  
Keyword(s):  
World Health Organization ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Point Prevalence ◽  
Prescribing Patterns ◽  
World Health ◽  
Antibiotic Prescribing ◽  
Full Time ◽  
Prevalence Survey ◽  
Health Organization

Abstract Background Few studies have been done on inpatient antibiotic use in Japan and antibiotic stewardship programs with dedicated full-time equivalents are rare. We sought to better understand inpatient antibiotic use in Okinawa, Japan. We applied the World Health Organization (WHO) Access, Watch and Reserve (AWaRe) Classification to compare our findings to international literature. Access antibiotics are common front-line antibiotics, Watch antibiotics are high-priority antibiotics with toxicity or resistance concerns, and Reserve antibiotics are last-line treatments for multi-drug resistant infections. Methods A point prevalence study was conducted in five hospitals in Okinawa, Japan on Oct 1, 2020. Physicians conducted chart reviews of all patients receiving intravenous antibiotics. Type of antibiotic, reason for use, duration, and microbiologic data was collected. The primary aim was to evaluate the proportion of patients who received antibiotics on the assessment date; secondary aims were to categorize antibiotics according to indication, class and AWaRe classification. Descriptive statistics were used to derive the distribution of AWaRe Classifications and drug class. Results 1,728 unique patients were included and 504 (29%) received ≥1 antibiotic on the assessment date. A total of 559 antibiotics were used for 504 patients and 22.0% (n=123) were for prophylaxis. Of those receiving antibiotics for treatment (N=436), 385 (88.3%) patients had a documented infection source. The most common indications for antibiotic use were pneumonia (24.2% n=93), urinary tract infection (19.7% n=76), and intraabdominal (17.9% n=69). Overall, 43.1% (n=241) of the antibiotics were categorized Access and 54.4% (n=304) Watch [Figure 1]. Cephalosporins were the most common antibiotic class (56% n=313), followed by β-lactam inhibitors (18% n=106) and narrow penicillins (8.2% n=46) [Figure 2]. Conclusion 29% of inpatients in these 5 Okinawan hospitals were prescribed an antibiotic on the survey date. A majority of antibiotics used fall under the WHO AWaRe Watch classification which are antibiotics that may be more likely to cause resistance. Understanding appropriateness of antibiotics used in this population could inform antibiotic stewardship strategies and reduce antibiotic resistance. Figure 1. Antibiotic Distribution According to World Health Organization (WHO) Access, Watch and Reserve (AWaRe) Classification Figure 2. Antibiotic Distribution by Class in Okinawan Hospitals Disclosures All Authors: No reported disclosures

A Veterans’ Healthcare Administration (VHA) antibiotic stewardship intervention to improve outpatient antibiotic use for acute respiratory infections: A cost-effectiveness analysis

2021 ◽  
pp. 1-7
Author(s):  
Minkyoung Yoo ◽  
Karl Madaras-Kelly ◽  
McKenna Nevers ◽  
Katherine E. Fleming-Dutra ◽  
Adam L. Hersh ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Antibiotic Treatment ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
System Perspective ◽  
Life Years ◽  
Intervention Cost ◽  
Core Elements ◽  
Tract Infections

Abstract Objectives: The Core Elements of Outpatient Antibiotic Stewardship provides a framework to improve antibiotic use, but cost-effectiveness data on implementation of outpatient antibiotic stewardship interventions are limited. We evaluated the cost-effectiveness of Core Element implementation in the outpatient setting. Methods: An economic simulation model from the health-system perspective was developed for patients presenting to outpatient settings with uncomplicated acute respiratory tract infections (ARI). Effectiveness was measured as quality-adjusted life years (QALYs). Cost and utility parameters for antibiotic treatment, adverse drug events (ADEs), and healthcare utilization were obtained from the literature. Probabilities for antibiotic treatment and appropriateness, ADEs, hospitalization, and return ARI visits were estimated from 16,712 and 51,275 patient visits in intervention and control sites during the pre- and post-implementation periods, respectively. Data for materials and labor to perform the stewardship activities were used to estimate intervention cost. We performed a one-way and probabilistic sensitivity analysis (PSA) using 1,000,000 second-order Monte Carlo simulations on input parameters. Results: The proportion of ARI patient-visits with antibiotics prescribed in intervention sites was lower (62% vs 74%) and appropriate treatment higher (51% vs 41%) after implementation, compared to control sites. The estimated intervention cost over a 2-year period was $133,604 (2018 US dollars). The intervention had lower mean costs ($528 vs $565) and similar mean QALYs (0.869 vs 0.868) per patient compared to usual care. In the PSA, the intervention was dominant in 63% of iterations. Conclusions: Implementation of the CDC Core Elements in the outpatient setting was a cost-effective strategy.

Thinking Beyond the “Core” Antibiotic Stewardship Interventions: Shifting the Onus for Appropriate Antibiotic Use from Stewardship Teams to Prescribing Clinicians

2020 ◽  
Author(s):  
Timothy C Jenkins ◽  
Pranita D Tamma
Keyword(s):  
Antibiotic Stewardship ◽  
Paradigm Shift ◽  
Daily Practice ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prior Authorization ◽  
Prospective Audit ◽  
The Core ◽  
Primary Focus ◽  
Prospective Audit And Feedback

Abstract United States guidance for hospital antibiotic stewardship has emphasized prospective audit and feedback and prior authorization of select antibiotics as core interventions. These remain the most common interventions implemented by stewardship programs. Although these approaches have been shown to reduce unnecessary antibiotic use, they incorrectly put the onus for appropriate antibiotic use on the stewardship team rather than the prescribing clinician. We propose that a primary focus of stewardship programs should be implementation of broader interventions that engage frontline clinicians and equip them with tools to integrate antibiotic stewardship into their own daily practice, thus reducing the need for day-to-day stewardship team oversite. We discuss a framework of broader interventions and policies that will facilitate this paradigm shift.

scholarly journals VA Antibiotic Stewardship Intervention to Improve Outpatient Antibiotic Use for ARIs: A Cost-Effectiveness Analysis

2020 ◽  
Vol 41 (S1) ◽  
pp. s55-s55
Author(s):  
Minkyoung Yoo ◽  
Richard Nelson ◽  
McKenna Nevers ◽  
Karl Madaras-Kelly ◽  
Katherine Fleming-Dutra ◽  
...  
Keyword(s):  
Monte Carlo ◽  
Cost Effectiveness ◽  
Healthcare Utilization ◽  
Antibiotic Treatment ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Core Elements ◽  
Tract Infections ◽  
The Cost

Background: The Core Elements of Outpatient Antibiotic Stewardship provide a framework to improve antibiotic use, but cost-effectiveness data on interventions to improve antibiotic use are limited. Beginning in September 2017, an antibiotic stewardship intervention was launched in within 10 outpatient Veterans Healthcare Administration clinics. The intervention was based on the Core Elements and used an academic detailing (AD) and an audit and feedback (AF) approach to encourage appropriate use of antibiotics. The objective of this analysis was to evaluate the cost-effectiveness of the intervention among patients with uncomplicated acute respiratory tract infections (ARI). Methods: We developed an economic simulation model from the VA’s perspective for patients presenting for an index outpatient clinic visit with an ARI (Fig. 1). Effectiveness was measured as quality-adjusted life-years (QALYs). Cost and utility parameters for antibiotic treatment, adverse drug reactions (ADRs), and healthcare utilization were obtained from the published literature. Probability parameters for antibiotic treatment, appropriateness of treatment, antibiotic ADRs, hospitalization, and return ARI visits were estimated using VA Corporate Data Warehouse data from a total of 22,137 patients in the 10 clinics during 2014–2019 before and after the intervention. Detailed cost data on the development of the AD and AF materials and electronically captured time and effort for the National AD Service activities by specific providers from a national ARI campaign were used as a proxy for the cost estimate of similar activities conducted in this intervention. We performed 1-way and probabilistic sensitivity analyses (PSAs) using 10,000 second-order Monte Carlo simulations on costs and utility values using their means and standard deviations. Results: The proportion of uncomplicated ARI visits with antibiotics prescribed (59% vs 40%) was lower and appropriate treatment was higher (24% vs 32%) after the intervention. The intervention was estimated to cost $110,846 (2018 USD) over a 2-year period. Compared to no intervention, the intervention had lower mean costs ($880 vs $517) and higher mean QALYs (0.837 vs 0.863) per patient because of reduced inappropriate treatment, ADRs, and subsequent healthcare utilization, including hospitalization. In threshold analyses, the antibiotic stewardship strategy was no longer dominant if intervention cost was >$64,415,000 or the number of patients cared for was <3,672. In the PSA, the antibiotic stewardship intervention was dominant in 100% of the 10,000 Monte Carlo iterations (Fig. 2). Conclusions: In every scenario, the VA outpatient AD and AF antibiotic stewardship intervention was a dominant strategy compared to no intervention.Funding: NoneDisclosures: None

scholarly journals A Tool for Promoting Responsible Antibiotic Prescribing across Settings and Sectors

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Anette Hulth ◽  
Sonja Lofmark ◽  
Jeff Andre ◽  
Rachel Chorney ◽  
Emily Cohn ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Resistance ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Web Based ◽  
Antimicrobial Prescribing ◽  
Cochrane Database ◽  
Resistance Data

ObjectiveTo develop, evaluate, and implement a universal online platform - termed OPEN Stewardship - to promote responsible antimicrobial prescribing (antimicrobial stewardship).IntroductionAntibiotic resistance is a mounting public health threat calling for action on global, national and local levels. Antibiotic use has been a major driver of increasing rates of antibiotic resistance. This has given rise to the practice of antibiotic stewardship, which seeks to reduce unnecessary antibiotic use across different care settings. Antibiotic stewardship has been increasingly applied in hospital settings, but adoption has been slow in many ambulatory care settings including primary care of humans. Uptake of antibiotic stewardship in veterinary care has been similarly limited. Audit and feedback systems of antibiotic use coupled with patterns of antibiotic use and best practice guidelines have proven useful in outpatient settings, but scale-up is limited by heterogeneous systems of care and limited resources.MethodsA multi-sectoral team with partners from Canada, Israel and Sweden is developing a web-based platform for administering antibiotic stewardship across multiple care settings and sectors, for human and animal prescribers. There are several interventions which support behaviour change and can be applied to antibiotic stewardship programs. Systematic reviews have found beneficial effects of numerous behaviour change interventions for optimizing clinical practice such as computerized reminders [1], opinion leaders as champions for change [2], and audit and feedback [3]. A recent Cochrane review [4] found that interventions to enable correct use of antibiotics improved policy compliance, and that enabling interventions that included feedback were more likely to be effective. We will use antibiotic prescribing benchmarking, focused guidelines, and local patterns of antibiotic resistance as key components that can be deployed as feedback through this antibiotic stewardship platform.The OPEN Stewardship platform will be hosted on an AWS cloud-based server using industry standard encryption. The platform will function with a central administrator who will enroll and deliver feedback to participating prescribers. This platform will be evaluated prospectively in two countries (Canada and Israel) to evaluate user experience of the feedback as well as impact on antimicrobial prescribing. The evaluation will include prescribers from both human and animal health. After the prospective evaluation, the platform will be made available online for broad multi-sectoral use.ResultsWe have designed the interface for a web-based platform for antibiotic stewardship which will be used in a multinational prospective primary care stewardship intervention in 2019 and 2020 and subsequently rolled out for broad public use (www.openasp.org). The platform layout can be seen in Figure 1. Data capture for aggregate prescriber level antibiotic use and local guidelines will be possible through both a manual graphical user interface and a dataset template upload. Antibiotic resistance data will be pulled from a companion database (www.resistanceopen.org). Administrators will be able to generate unique feedback forms containing visualizations and snapshots from antibiotic use, guidelines, and antibiotic resistance data (Figure 2). These can then be delivered by email on an individual or scheduled basis for one or multiple prescribers simultaneously. Participating prescribers will also have the option to login to view their own profile and browse antibiotic use, resistance and guidelines.ConclusionsAntibiotic stewardship needs to be adopted in a fashion that is country and context specific and not administered from the top down. With our approach we seek to empower groups from any country or care setting to provide regional and tailored stewardship feedback through an open interface. We have here demonstrated the design of an web-based antibiotic stewardship platform which will be evaluated prospectively and subsequently made available for open and broad multi-sectoral use - in keeping with a One Health approach.References1. Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD001096.2. Flodgren G, Eccles MP, Shepperd S, Scott A, Parmelli E, Beyer FR. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD009255.3. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012 Jun 13;(6):CD000259.4. Davey P, Brown E, Charani E, Fenelon L, Gould IM, Holmes A, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD003543. 

scholarly journals The state of antibiotic stewardship programs in 2021: The perspective of an experienced steward

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Tamar F. Barlam
Keyword(s):  
Antibiotic Stewardship ◽  
Treatment Guidelines ◽  
Therapy Monitoring ◽  
Local Treatment ◽  
Antibiotic Use ◽  
Leadership Role ◽  
Transitions Of Care ◽  
Audit And Feedback ◽  
Quality Health Care ◽  
Essential Components

Abstract Recognition of antibiotic stewardship programs (ASPs) as essential components of quality health care has dramatically increased in the past decade. The value of ASPs has been further reinforced during the coronavirus disease 2019 (COVID-19) pandemic because these programs were instrumental in monitoring antibiotic use, assessing emerging COVID-19 therapies, and coordinating implementation of monoclonal antibody infusions and vaccinations. ASPs are now required across hospital settings as a condition of participation for the Centers for Medicare and Medicaid Services and for accreditation by The Joint Commission. In the 2019 National Healthcare Safety Network annual survey, almost 89% of hospitals met the Seven Core Elements for ASPs defined by the Centers for Disease Control and Prevention. More than 61% of programs were co-led by physicians and pharmacists, evidence of the leadership role of both groups. ASPs employ many strategies to improve prescribing. Core interventions of preauthorization for targeted antibiotics, prospective audit and feedback, and development of local treatment guidelines have been supplemented with numerous emerging strategies. Diagnostic stewardship, optimizing duration of therapy, promoting appropriate conversion from intravenous to oral therapy, monitoring at transitions of care and hospital discharge, implementing stewardship initiatives in the outpatient setting, and increasing use of telemedicine are approaches being adopted across hospital settings. As a core function for medical facilities, ASP leaders must ensure that antibiotic use and ASP interventions promote optimal and equitable care. The urgency of success becomes progressively greater as complex patterns of antibiotic resistance continue to emerge, exacerbated by unpredictable factors such as a worldwide pandemic.

scholarly journals Antibiotic Stewardship Implementation at Hospitals Without On-Site Infectious Disease Specialists: A Mixed-Methods Study

2021 ◽  
Vol 1 (S1) ◽  
pp. s65-s65
Author(s):  
Daniel Livorsi ◽  
Eli Perencevich ◽  
Kenda Stewart Steffensmeier ◽  
Matthew Goetz ◽  
Heather Reisinger
Keyword(s):  
Infectious Disease ◽  
Acute Care ◽  
Antibiotic Stewardship ◽  
Long Term Care ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Full Time ◽  
Term Care ◽  
Days Of Therapy

Background: Hospitals are required to have antibiotic stewardship programs (ASPs), but there are few models for implementing ASPs without the support of an infectious disease (ID) specialist, defined as an ID physician and/or ID pharmacist. In this study, we sought to understand ASP implementation at hospitals within the Veterans’ Health Administration (VHA) that lack on-site ID support. Methods: Using a mandatory 2016 VHA survey, we identified acute-care hospitals that lacked an on-site ID specialist. For each hospital, antibiotic use (2018–2019) was quantified as days of therapy (DOT) per 1,000 days present, based on NHSN methodology for tracking all antibacterial agents. From July 2019 through April 2020, we conducted semistructured interviews with personnel involved in or affected by ASP activities at 7 qualifying hospitals. All interview transcripts were analyzed using thematic content analysis. Results: Of the 7 acute-care hospitals, 6 (86%) had a long-term care unit; 3 (43%) had an intensive care unit; and 2 (29%) had full-time employment equivalents dedicated to stewardship. Sites averaged 1,075 (SD, ±654) and 148 (SD, ±96) admissions per year in acute-care and long-term care, respectively. At the site-level, mean antibiotic use was 486 DOT (SD, ±98) per 1,000 days-present in acute-care and 207 DOT (SD, ±74) per 1,000 days present in long-term care. We interviewed 42 personnel across the 7 sites. Although sites reported using similar interventions to promote antibiotic stewardship, the shape of these interventions varied. The following 4 common themes were identified: (1) The primary responsibility for ASPs fell on the pharmacist champions, who were typically assigned multiple other non-ASP responsibilities. (2) The pharmacist champions were more successful at gaining buy-in for stewardship initiatives when they had established rapport with clinicians, but at some sites, the use of contract physicians and frequent staff turnover were potential barriers. (3) Some sites felt that having access to an off-site ID specialist was important for overcoming institutional barriers to stewardship and improving the acceptance of their stewardship interventions. (4) In general, stewardship champions struggled to mobilize institutional resources, which made it difficult to advance their programmatic goals. Conclusions: In this study of 7 hospitals without local ID support, we found that ASPs are largely a pharmacy-driven process. Remote ID support, if available, was seen as helpful for implementing stewardship interventions. These findings may inform the future implementation of ASPs in settings lacking local ID expertise.Funding: NoDisclosures: None

scholarly journals 78. Outcomes and adherence to institutional empiric therapy guidelines for the treatment of cystitis in ambulatory male veterans

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S56-S57
Author(s):  
Selena N Pham ◽  
Chester Ashong ◽  
Maria C Rodriguez-Barradas ◽  
Andrew Hunter
Keyword(s):  
Treatment Options ◽  
Treatment Success ◽  
Asymptomatic Bacteriuria ◽  
Group Versus ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
High Rate ◽  
Audit And Feedback ◽  
First Line ◽  
Duration Of Treatment

Abstract Background Guidelines provide primary literature demonstrating efficacy and safety of cystitis treatment in female patients, but not males. Increased antimicrobial resistance of urinary tract infection (UTI) pathogens to first line antibiotics are well-documented. In 2017, a change in institutional guidelines was made to recommend nitrofurantoin (NF) or cefpodoxime (CPD) as first line antibiotics for cystitis in males. This study aims to evaluate the efficacy of NF and CPD as first line treatment options in males with cystitis. Methods Single-center, retrospective chart review of male patients prescribed NF or CPD for treatment of cystitis in the outpatient setting from August 2017 to August 2018. Patients with asymptomatic bacteriuria, prostatitis or systemic signs and symptoms of UTI were excluded. Primary outcome was treatment failure, defined as requiring new emergency department (ED) or patient aligned care team (PACT) visit within 30 days after initiation of antibiotic for unresolved symptoms. Safety outcomes were based on documented adverse effects (AE) associated with antibiotic use. Chi-square was the primary statistical test for analyzing primary outcomes and other nominal variables. Results A total of 450 charts were reviewed with 150 patients meeting inclusion criteria (NF n = 75, CPD n = 75). Baseline characteristics were equally distributed between the two groups although the CPD group had higher serum creatinine compared to the NF group (p = 0.05). Nine patients (12%) in the NF group versus 13 patients (17.3%) in the CPD group returned to ED or PACT within 30 days (p=0.36). Inappropriate dosing was seen in 13 patients (17.3%) in the NF group vs. 2 patients (2.7%) in the CPD group (p = 0.005) and 44 patients (58.7%) in the NF group vs. 37 patients (49.3%) in the CPD group who received an inappropriate duration of treatment (p = 0.25). None of the patients reported AE associated with antibiotic use. Conclusion Treatment success rate of NF and CPD (88% and 82.7%, respectively) suggests that these agents might be effective first line antibiotics for cystitis in males. High rate of inappropriate long duration of treatment indicates the need for staff education and prospective audit and feedback for outpatient stewardship interventions. Disclosures All Authors: No reported disclosures

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