scholarly journals Leveraging Antimicrobial Stewardship in the Emergency Department to Improve the Quality of Urinary Tract Infection Management and Outcomes

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
Sarah C J Jorgensen ◽  
Samantha L Yeung ◽  
Mira Zurayk ◽  
Jill Terry ◽  
Maureen Dunn ◽  
...  
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Stewardship ◽  
Treatment Algorithm ◽  
Rapid Change ◽  
Audit And Feedback ◽  
Prescribing Practices ◽  
Return Visits

Abstract Background The complex and fast-paced emergency department (ED) practice setting presents unique challenges that demand a tailored approach to antimicrobial stewardship. In this article, we describe the strategies applied by 1 institution’s antimicrobial stewardship program (ASP) that were successful in improving prescribing practices and outcomes for urinary tract infection (UTI) in the ED. Methods Core strategies included pre-implementation research characterizing the patient population, antimicrobial resistance patterns, prescribing behavior, and morbidity related to infection; collaboration across multiple disciplines; development and implementation of a UTI treatment algorithm; education to increase awareness of the algorithm and the background and rationale supporting it; audit and feedback; and early evaluation of post-implementation outcomes. Results We observed a rapid change in prescribing post-implementation with increased empiric nitrofurantoin use and reduced cephalosporin use (P < .05). Our elevation of nitrofurantoin to firstline status was supported by our post-implementation analysis showing that its use was independently associated with reduced 30-day return visits (adjusted odds ratio, 0.547; 95% confidence interval, 0.312–0.960). Furthermore, despite a shift to a higher risk population and a corresponding decrease in antimicrobial susceptibility rates post-implementation, the preferential use of nitrofurantoin did not result in higher bug-drug mismatches while 30-day return visits to the ED remained stable. Conclusions We demonstrate that an outcomes-based ASP can impart meaningful change to knowledge and attitudes affecting prescribing practices in the ED. The success of our program may be used by other institutions as support for ASP expansion to the ED.

Oral Narrow-Spectrum Antibiotics for the Treatment of Urinary Tract Infection in Infants Younger Than 60 Days

2019 ◽  
Vol 9 (3) ◽  
pp. 378-381 ◽  
Author(s):  
Marisol Fernandez ◽  
Kathyrn Givens Merkel ◽  
Julio D Ortiz ◽  
Rachel Downey Quick
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Stewardship ◽  
Education Intervention ◽  
Oral Antibiotics ◽  
Prescribing Practices ◽  
Narrow Spectrum ◽  
Successful Outcomes

Abstract Data on the outcome of infants younger than 60 days treated with a combination of intravenous and oral antibiotics for urinary tract infection are limited. This study examined susceptibility and successful outcomes of treatment with narrow-spectrum oral antibiotics. In addition, we describe the effects of antimicrobial stewardship education intervention on prescribing practices.

Risk factors for early return visits to the emergency department in patients with urinary tract infection

2018 ◽  
Vol 36 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Sarah Jorgensen ◽  
Mira Zurayk ◽  
Samantha Yeung ◽  
Jill Terry ◽  
Maureen Dunn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Early Return ◽  
Return Visits

Urinary Tract Infection and Antimicrobial Stewardship in the Emergency Department

2018 ◽  
Vol 34 (2) ◽  
pp. 93-95 ◽  
Author(s):  
Joshua R. Watson ◽  
Pablo J. Sánchez ◽  
John David Spencer ◽  
Daniel M. Cohen ◽  
David S. Hains
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Stewardship

scholarly journals Creation and implementation of a urinary tract infection diagnostic and treatment algorithm for psychiatric inpatients with a communication barrier

2020 ◽  
Vol 10 (2) ◽  
pp. 64-69 ◽  
Author(s):  
Christine Rarrick ◽  
Amy Hebbard
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Interdisciplinary Collaboration ◽  
Treatment Algorithm ◽  
Psychiatric Emergency ◽  
Diagnosis And Treatment ◽  
Psychiatric Admission ◽  
Communication Barrier

Abstract Background Urinary tract infection (UTI) is considered a common cause of mental status changes, particularly in elderly patients and patients with a psychiatric condition. Genitourinary symptoms are essential to confirm UTI diagnosis but may be unobtainable in patients with a communication barrier. Sparse guidance suggests assessing specific symptoms that do not rely on patient report. The primary objective of this project was to provide assistance in diagnosis and treatment of UTIs in noncommunicative patients through the creation of an algorithm. Algorithm Creation and Implementation Through extensive interdisciplinary collaboration, the authors developed criteria to identify UTI symptoms that do not require communication. In order to make the algorithm comprehensive, we chose to include general information related to UTI diagnosis and treatment. The algorithm was implemented within the psychiatric emergency department as this is where patients are evaluated to determine need for psychiatric admission. Providers in the psychiatric emergency department were provided with detailed education on the algorithm as well as information about UTI diagnosis and treatment. Discussion Creating an algorithm within our institution required significant interdisciplinary collaboration. Providers were receptive to and appreciative of a comprehensive resource to assist in this difficult clinical situation. The authors plan to study the effects of algorithm implementation, specifically assessing changes in symptom documentation and antibiotic use.

scholarly journals 1353. Pediatric Urinary Tract Infections: A Choosing Wisely Initiative to Advance Antimicrobial Stewardship and Diagnostic Accuracy in the Emergency Department

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S687-S688
Author(s):  
Michael Prodanuk ◽  
Yen Foong ◽  
Valene Singh ◽  
Laura Morrissey ◽  
Michelle Science ◽  
...  
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Stewardship ◽  
Urine Culture ◽  
Diagnostic Algorithm ◽  
Choosing Wisely ◽  
Positive Urine ◽  
Antibiotic Duration

Abstract Background Urinary tract infection (UTI) is a common diagnosis in the pediatric emergency department (ED) that often results in empiric antibiotic treatment prior to culture results. A 2016 cohort study from our centre found that 47% of children diagnosed with a UTI and prescribed antibiotics had a negative urine culture. None of these patients were notified of the misdiagnosis or told to discontinue antibiotics. Figure 1: Choosing Wisely pediatric urinary tract infection diagnostic algorithm Figure 2: Patients included/excluded with exclusion criteria Methods Institutional approval was obtained for a quality improvement project in our quaternary pediatric ED. For uncomplicated pediatric UTIs, the aim was to reduce misdiagnosis by 50% and promote antimicrobial stewardship over a 24-month period. Using the Model for Improvement, two interventions were implemented using PDSA cycles: (1) a UTI diagnostic algorithm embedded in the electronic medical record, (2) a urine culture callback system. Outcome measures included the percentage of patients with UTI misdiagnosis (urine culture negative) and antibiotic-days saved. Process measures included adherence to the UTI algorithm and callback system as well as antibiotic duration standardization. As a balancing measure, patients developing positive urine cultures without UTI diagnosis were reviewed for potential harm. Figure 3: Run chart of urinary tract infection misdiagnosis rate Figure 4: Callback system - Percent patients contacted and antibiotics-days saved Results From June 2017-April 2020, 2,183 children (0.97% of all visits) were diagnosed with a UTI in the ED. 1,381 (63.3%) met inclusion criteria for analysis. Following UTI algorithm launch, median UTI misdiagnosis decreased by 20% (52.5% vs. 32.5%), median correct antibiotic duration increased by 30% (45.2% vs. 75.1%), and algorithm adherence was 78.9%. With implementation of the callback system, 1,678 antibiotic-days were saved as mean patients contacted to discontinue antibiotics increased from 0% to 76.8%. Of 106 patients with positive urine cultures with missed UTI diagnosis over a 29-month period, 8 patients returned to the ED within 72 hours and 2 patients required admission for intravenous antibiotics. Conclusion Implementation of a UTI diagnostic algorithm and urine culture callback system for uncomplicated pediatric UTIs reduced UTI misdiagnosis and promoted antimicrobial and resource stewardship in the ED. Future directions include improving UTI algorithm adherence through targeted clinician audit and feedback, plus sustainability planning. Disclosures Olivia Ostrow, MD, Choosing Wisely Canada (Advisor or Review Panel member)

National Trends in Emergency Department Antibiotic Prescribing for Elders with Urinary Tract Infection, 1996-2005

2009 ◽  
Vol 16 (6) ◽  
pp. 500-507 ◽  
Author(s):  
Jeffrey M. Caterino ◽  
Sarah Grace Weed ◽  
Janice A. Espinola ◽  
Carlos A. Camargo, Jr
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antibiotic Prescribing ◽  
National Trends

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

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