scholarly journals 1115. Reducing Broad-Spectrum Antibiotics for Uncomplicated Urinary Tract Infections: A Multimodal Stewardship Intervention

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S396-S397
Author(s):  
Maryrose R Laguio-Vila ◽  
Mary L Staicu ◽  
Mary Lourdes Brundige ◽  
Jose Alcantara-Contreras ◽  
Hongmei Yang ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Phase I ◽  
Urinary Tract Infections ◽  
Broad Spectrum ◽  
Phase 1 ◽  
Phase 2 ◽  
Intervention Phase ◽  
Broad Spectrum Antibiotics ◽  
Stewardship Program ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are the second most common reason for antibiotics in hospitalized patients, with most receiving broad-spectrum antibiotics (BSA) regardless of infection severity. The antimicrobial stewardship program (ASP) conducted a multimodal stewardship intervention targeting reduction in one BSA, ceftriaxone, and promoted narrow-spectrum antibiotics (NSA) such as cefazolin and cephalexin for uncomplicated UTIs. Methods Phase 1: In February 2018, the ASP created a pocket card (Figure 1) containing (1) a urinary antibiogram outlining the most common urine pathogens and their local susceptibility to NSA and (2) NSA guidelines for UTIs with 0–1 systemic inflammatory response syndrome (SIRS) criteria. ASP performed a daily prospective audit with feedback on all new orders of ceftriaxone and promoted prescription of NSA. Phase 2: In August 2018, a Best Practice Alert (BPA) in the electronic medical record (EMR) was designed to interrupt providers ordering ceftriaxone with the indication of a UTI, and prompted NSA prescription instead. Quarterly didactic sessions on UTI antibiotic use and BPA functionality were done. We compared antibiotics usage rates across the 3 study phases (pre-intervention, phase I and phase II) by computing rate ratios (RRs) using Poisson regression. Results Compared with pre-intervention, phase 1 resulted in a significant decrease in ceftriaxone DOT (RR: 1.06, CI: 1.03–1.09, P < 0.001) and ceftriaxone orders for UTI (RR: 1.14, P < 0.001) and an increase in cefazolin DOT (RR: 0.89, P = 0.029) and orders for UTI (RR; 0.12, P < 0.001). It also resulted in a significant increase in cephalexin DOT (RR: 0.92, P = 0.002) and orders for UTI (RR: 0.58, P < 0.001). In phase 2, an additional significant reduction in ceftriaxone DOT (RR: 1.04, CI: 1.01–1.08, P = 0.018) and orders for UTI (RR: 1.62, P < 0.001) and an increase in cefazolin DOT (RR: 0.96, P < 0.001) and orders for UTI (RR; 0.56, P < 0.001) occurred, when comparing phase I to phase 2. It also resulted in a decrease in cephalexin DOT (RR: 0.83, P < 0.001) and orders for UTI (RR: 0.70, P < 0.001). Conclusion A multimodal stewardship intervention using a pocket card with guidelines and urine antibiogram, and an EMR BPA successfully reduced BSA and increased NSA for treatment of uncomplicated UTIs. Disclosures All authors: No reported disclosures.

scholarly journals 1107. Impact of Routine Education and Data Feedback on the Durability of an Antimicrobial Stewardship Intervention for Outpatient Urinary Tract Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S394-S394
Author(s):  
Jason Funaro ◽  
Rebekah W Moehring ◽  
Beiyu Liu ◽  
Hui-Jie Lee ◽  
Christina Sarubbi ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Phase 1 ◽  
Urgent Care ◽  
Phase 2 ◽  
Intervention Phase ◽  
Data Feedback ◽  
Specific Feedback ◽  
Initial Intervention ◽  
Tract Infections

Abstract Background Achieving lasting, sustainable effects in outpatient AS interventions has been a challenge for many programs. Our group observed an initial benefit of an outpatient AS intervention focused on diagnosis and management of urinary tract infections (UTIs). However, prescribing habits trended back toward baseline over time. This study aimed to evaluate the impact of routine education and comparative data feedback on the durability of an outpatient AS intervention for UTIs. Methods We conducted a prospective quasi-experimental study at one primary care (PC) and one urgent care (UC) clinic to evaluate the durability of an outpatient AS intervention implemented in August 2017 and November 2017, respectively. Clinicians who treated adult patients with a diagnosis of acute UTI at either clinic participated in the study. The initial intervention (phase 1) included development of clinic-specific antibiograms and UTI diagnosis and treatment guidelines. Approximately 12 months after the initial intervention, routine education along with clinic- and comparative provider-specific feedback reports were emailed to clinicians at regular intervals (phase 2). The primary outcome was percent of encounters in which first- or second-line antibiotics were prescribed. Pre- and post-intervention phase and trend changes were assessed using an interrupted time-series approach. Results Data were collected on 792 and 3,720 UTI encounters at PC and UC, respectively. In the 12 months after the initial intervention, rates of guideline concordance were 73% at PC and 57% at UC (Figures 1 and 2). After routine data feedback was provided for approximately 7 months at PC and 5 months at UC, rates of guideline concordance remained relatively stable at 75% for PC and 61% at UC. An initial 37% relative reduction in fluoroquinolone (FQ) use was observed during phase 1 which was further reduced by an additional 18% during phase 2. Conclusion Routine provision of clinic-specific feedback and peer comparisons sustained rates of guideline-concordant prescribing at two outpatient clinics. This intervention required significant resources for data analysis and delivery, but it was successful in decreasing rates of FQ prescribing and maintaining clinician engagement. Disclosures All authors: No reported disclosures.

scholarly journals Impact of Education and Data Feedback on Guideline Concordant Prescribing for Urinary Tract Infections in the Outpatient Setting

2021 ◽  
Author(s):  
Jason R Funaro ◽  
Rebekah W Moehring ◽  
Beiyu Liu ◽  
Hui-Jie Lee ◽  
Siyun Yang ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Phase 1 ◽  
Routine Data ◽  
Prescribing Patterns ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Phase 2 ◽  
Data Feedback ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are the most common outpatient indication for antibiotics and an important target for antimicrobial stewardship (AS) activities. With The Joint Commission standards now requiring outpatient AS, data supporting effective strategies are needed. Methods We conducted a two-phase, prospective, quasi-experimental study to estimate the effect of an outpatient AS intervention on guideline-concordant antibiotic prescribing in a primary care (PC) and urgent care (UC) clinic between August 2017 and July 2019. Phase 1 of the intervention included the development of clinic-specific antibiograms and UTI diagnosis and treatment guidelines, presented during educational sessions with clinic providers. Phase 2, consisting of routine clinic- and provider-specific feedback, began approximately twelve months after the initial education. The primary outcome was percent of encounters with first- or second-line antibiotics prescribed according to clinic-specific guidelines, and was assessed using an interrupted time series approach. Results Data were collected on 4,724 distinct patients seen during 6,318 UTI encounters. The percent of guideline-concordant prescribing increased by 22% (95% CI: 12% to 32%) after Phase 1 education, but decreased by 0.5% every two weeks afterwards (95% CI: -0.9% to 0%). Following routine data feedback in Phase 2, guideline concordance stabilized and significant further decline was not seen (-0.6%, 95% CI: -1.6% to 0.4%). This shift in prescribing patterns resulted in a 52% decrease in fluoroquinolone use. Conclusions Clinicians increased guideline-concordant prescribing, reduced UTI diagnoses, and limited use of high-collateral damage agents following this outpatient AS intervention. Routine data feedback was effective to maintain the response to the initial education.

scholarly journals Impact of selective reporting of antibiotic susceptibility test results in urinary tract infections in the outpatient setting: a protocol for a pragmatic, prospective quasi-experimental trial

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e025810 ◽  
Author(s):  
Francesca Binda ◽  
Sébastien Fougnot ◽  
Patrice De Monchy ◽  
Anne Fagot-Campagna ◽  
Céline Pulcini ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Broad Spectrum ◽  
Antibiotic Susceptibility ◽  
Outpatient Setting ◽  
Susceptibility Test ◽  
Selective Reporting ◽  
Broad Spectrum Antibiotics ◽  
Antibiotic Susceptibility Test ◽  
Tract Infections

IntroductionAntibiotic resistance is a serious and increasing worldwide threat to global public health. One of antibiotic stewardship programmes’ objectives are to reduce inappropriate broad-spectrum antibiotics’ prescription. Selective reporting of antibiotic susceptibility test (AST) results, which consists of reporting to prescribers only few (n=5-6) antibiotics, preferring first-line and narrow-spectrum agents, is one possible strategy advised in recommendations. However, selective reporting of AST has never been evaluated using an experimental design.Methods and analysisThis study is a pragmatic, prospective, multicentre, controlled (selective reporting vs usual complete reporting of AST), before-after (year 2019 vs 2017) study. Selective reporting of AST is scheduled to be implemented from September 2018 in the ATOUTBIO group of 21 laboratories for all Escherichia coli identified in urine cultures in adult outpatients, and to be compared with the usual complete AST performed in the EVOLAB group of 20 laboratories. The main objective is to assess the impact of selective reporting of AST for E. coli-positive urine cultures in the outpatient setting on the prescription of broad-spectrum antibiotics frequently used for urinary tract infections (amoxicillin-clavulanate, third-generation cephalosporins and fluoroquinolones). The primary end point is the after (2019)–before (2017) difference in prescription rates for the previously mentioned antibiotics/classes that will be compared between the two laboratory groups, using linear regression models. Secondary objectives are to evaluate the feasibility of selective reporting of AST implementation by French laboratories and their acceptability by organising focus groups and individual semi-structured interviews with general practitioners and laboratory professionals.Ethics and disseminationThis protocol was approved by French national ethics committees (Comité d’expertise pour les recherches, les études et les évaluations dans le domaine de la santé (TPS 29064) and Commission Nationale de l’Informatique et des Libertés (Décision DR-2018–141)). Findings of this study will be widely disseminated through conference presentations, reports, factsheets and academic publications and generalisation will be further discussed.Trial registration numberNTC03612297.

scholarly journals 1446. The Impact of Enterobacteriaceae Isolate Breakpoints on Prescriber Treatment Choices for Discordant Pattern Urinary Tract Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S528-S528
Author(s):  
Philip Lee ◽  
Yi Guo ◽  
Wendy Szymczak ◽  
Vijaya L Soma ◽  
Priya Nori
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Broad Spectrum ◽  
White Blood Cells ◽  
Narrow Spectrum ◽  
Broad Spectrum Antibiotics ◽  
Group A ◽  
Group B ◽  
Tract Infections ◽  
The Impact

Abstract Background Our institution revealed Enterobacteriaceae with discordant cefazolin (CEF)-resistant / ampicillin-sulbactam (SAM) susceptible patterns (CRASS-P). This discordance could be from the multiple MIC cephalosporin breakpoint adjustments from CLSI. SAM has higher resistance for gram-negative bacteria compared with cephalosporins such as CEF which is confirmed by our antibiogram. We sought to understand if narrow-spectrum antibiotic choices for CRASS-P urinary tract infections (UTIs) led to clinical cure (CC). Methods We conducted a retrospective review from January 2018 to February 2019 of all CRASS-P Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae isolates from urine cultures. Patients with any symptom related to a UTI, urinalysis with >10 white blood cells/high-powered field, urine culture with >10,000 colony-forming units/mL, and receipt of an antibiotic were included. CC was defined as symptom resolution within 48 hours with no return to care within 28 days of the positive urinary culture. “Group A” included patients prescribed narrow-spectrum antibiotics such SAM, CEF, or an oral cephalosporin (OC) vs. broad-spectrum antibiotics such as ceftriaxone, quinolones or sulfa-medications (“Group B”). Results There were 960/1356 (70.8%) CRASS-P urinary isolates and 244 patients met inclusion criteria. Of 244 patients, 72 were in Group A and 172 were in Group B. There was no difference in the diversity of the 3 uropathogens, P = 0.34 (Table 1). Median age was 69±20.3 and 67.5±23.9 years for Group A and Group B, respectively, P = 0.23. Females accounted for 73.6% and 77.9% in Group A and B, respectively, P = 0.51. Overall, patients reached CC in 98.6% (71/72) of Group A patients, compared with 92.4% (159/172) of Group B patients, P = 0.07. Antibiotics used in treatment are outlined in Figure 1. UTI was associated with bacteremia for 2 patients in Group A and 4 patients in Group B (P = 0.84). Both patients in Group A reached CC and used AMC for treatment. However, 1 out of 4 patients did not achieve CC in Group B. Conclusion The use of SAM or OC can spare the broad-spectrum antibiotics use for CRASS-P UTIs as there was no statistical difference in CC between the two groups. The use of SAM with CRASS-P bacteremia secondary to UTI is possible; however, future studies are needed. Disclosures All authors: No reported disclosures.

scholarly journals 1125. In with the Out-patient Antimicrobial Stewardship Initiative: A Collaboration between a Children’s Hospital Antimicrobial Stewardship Program and a Nonaffiliated Pediatric Private Practice

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S400-S400
Author(s):  
Katie Namtu ◽  
David M Berman ◽  
Catherine Hough-Telford
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Prescribing Patterns ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Resistance Patterns ◽  
Outpatient Practice ◽  
Tract Infections

Abstract Background While antibiotic stewardship programs have been well described in the inpatient setting, data on effectiveness and guidance on implementing outpatient stewardship in pediatric patients is scarce. To the best of our knowledge, this is the first study describing the impact that an established inpatient pediatric antimicrobial stewardship program (ASP) has had on antimicrobial prescribing practices in a multi-site (14 locations) nonacademic, nonaffiliated pediatric outpatient practice. This study’s main objective was to compare the prescribing patterns for urinary tract infections (UTIs) at baseline (before education was provided on local uropathogen resistance patterns, implications of broad-spectrum antibiotic usage, national practice guidelines, cost, etc.) and after antimicrobial stewardship education and interventions. Methods Prescribing patterns for UTIs at baseline were reviewed and assessed for appropriateness by the inpatient ASP the summer of 2018. Following this review, education was provided to the outpatient prescribers that included discussion on local uropathogen resistance patterns, UTI guidelines, antimicrobial properties, risk for adverse effects, appropriate antimicrobial selections and dosing for UTIs. After education was provided prescribing patterns from the various sites and prescribers was reviewed on a quarterly basis. Email reminders were also sent out to providers reminding them to use cephalexin as first-line treatment. Unblinded peer comparison was utilized as a behavioral intervention in which all prescribers received reports comparing their antibiotic prescribing rates for UTIs to their peers. Results The rate by which cephalexin was prescribed for UTIs has steadily improved from 4.02% of all prescriptions for UTIs during the reporting period of December 2017 - February 28, 2018 to 67.55% during the reporting period January 1 - March 31, 2019. Conclusion Collaboration between an established inpatient pediatric ASP and a nonaffiliate, multi-site private pediatric outpatient practice resulted in decreased utilization of broad-spectrum antibiotics and optimization of empiric treatment of urinary tract infections based on local resistance patterns. Disclosures All authors: No reported disclosures

scholarly journals Longitudinal Impact of APRNs on Nursing Home Quality Measures in the Missouri Quality Initiative

2021 ◽  
Author(s):  
Marilyn Rantz ◽  
G. F. Petroski ◽  
L. L. Popejoy ◽  
A. A. Vogelsmeier ◽  
K. E. Canada ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Phase 1 ◽  
Quality Measures ◽  
The State ◽  
Full Time ◽  
Improve Quality ◽  
Phase 2 ◽  
Intervention Phase ◽  
Tract Infections

Abstract Objectives To measure the impact of advanced practice nurses (APRNs) on quality measures (QM) scores of nursing homes (NHs) in the CMS funded Missouri Quality Initiative (MOQI) that was designed to reduce avoidable hospitalizations of NH residents, improve quality of care, and reduce overall healthcare spending. Design A four group comparative analysis of longitudinal data from September 2013 thru December 2019. Setting NHs in the interventions of both Phases 1 (2012–2016) and 2 (2016–2020) of MOQI (n=16) in the St. Louis area; matched comparations in the same counties as MOQI NHs (n=27); selected Phase 2 payment intervention NHs in Missouri (n=24); NHs in the remainder of the state (n=406). Participants NHs in Missouri Intervention: Phase 1 of The Missouri Quality Initiative (MOQI), a Centers for Medicare and Medicaid (CMS) Innovations Center funded research initiative, was a multifaceted intervention in NHs in the Midwest, which embedded full-time APRNs in participating NHs to reduce hospitalizations and improve care of NH residents. Phase 2 extended the MOQI intervention in the original intervention NHs and added a CMS designed Payment Intervention; Phase 2 added a second group of NHs to receive the Payment. Intervention Only. Measurements Eight QMs selected by CMS for the Initiative were falls, pressure ulcers, urinary tract infections, indwelling catheters, restraint use, activities of daily living, weight loss, and antipsychotic medication use. For each of the monthly QMs (2013 thru 2019) an unobserved components model (UCM) was fitted for comparison of groups. Results The analysis of QMs reveals that that the MOQI Intervention + Payment group (group with the embedded APRNs) outperformed all comparison groups: matched comparison with neither intervention, Payment Intervention only, and remainder of the state. Conclusion These results confirm the QM analyses of Phase 1, that MOQI NHs with full-time APRNs are effective to improve quality of care.

scholarly journals Infection surveillance analysis of catheter associated urinary tract infections in obstetrics and gynecology department of a tertiary care hospital of Central India

2017 ◽  
Vol 7 (1) ◽  
pp. 215
Author(s):  
Mudita Jain ◽  
Rituja Kaushal ◽  
Malini Bharadwaj
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Tertiary Care ◽  
Central India ◽  
Integrated Approach ◽  
Obstetrics And Gynecology ◽  
Care Hospital ◽  
Stewardship Program ◽  
Tract Infections ◽  
A Prospective Study

Background: The prevalence of catheter associated urinary tract infections (CAUTIs) in the catheterized patients in acute care settings (catheter used for <7 days) is 3%-7%, in patients who require a urinary catheter for >7 days, it is up to 25% and it approaches 100% after 30 days. As device related hospital acquired infections are imposing major threats in surgical realm of medical sciences, this study was undertaken with the objective to asses catheter related urinary tract infections magnitude.Methods: This study was undertaken in a tertiary care setting of Obstetrics and Gynecology Department of a Central Indian city. It is a prospective study conducted over a full year span from April 2016 to March 2017.Results: CAUTI was calculated as 8.95 per thousand catheter days for the whole study period. Out of the total number of 18 urinary isolates, E. Coli and Enterococcus species were more commonly implicated.Conclusions: In order to restraint the enigma, a multidisciplinary integrated approach including periodic training sessions for all health care workers based on bundled care interventions supervisory checklists etc. is needed. Aseptic techniques along with IDSA (Infectious disease society of America) guidelines/other similar protocols are recommended to bring down overall prevalence. Prudent use of antibiotics is to be accorded as per antibiotic stewardship program to combat drug resistance.

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