scholarly journals Duration of Antibiotic Therapy for General Medicine and General Surgery Patients Throughout Transitions of Care: An Antibiotic Stewardship Opportunity for Noninfectious Disease Pharmacists

2020 ◽  
pp. 001857872092826
Author(s):  
Kristin I. Brower ◽  
Ariel Hecke ◽  
Julie E. Mangino ◽  
Anthony T. Gerlach ◽  
Debra A. Goff
Keyword(s):  
Antibiotic Therapy ◽  
General Surgery ◽  
Antibiotic Stewardship ◽  
Total Duration ◽  
Outpatient Setting ◽  
Transitions Of Care ◽  
National Guidelines ◽  
Duration Of Therapy ◽  
Antibiotic Duration ◽  
Tract Infections

Background Overuse of antibiotics from the inpatient to outpatient setting is an antibiotic stewardship initiative where noninfectious disease (ID) pharmacists can have a large impact. Our purpose was to evaluate antibiotic durations across transitions of care from the inpatient to outpatient setting. Methods: This is a single-center, retrospective cohort analysis evaluating antibiotic durations from the inpatient and outpatient setting in adult patients admitted to general surgery and medicine services at an academic medical center between January 1, 2017 and September 20, 2017. The primary outcome was to assess total antibiotic duration for patients with uncomplicated and complicated urinary tract infections (UTI, cUTI), community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP). Outpatient electronic discharge prescriptions were used to calculate intended antibiotic duration upon transitions of care. Excessive duration of therapy was defined as >3 days—UTI, >5 days—CAP, and >7 days—cUTI or HAP. Results: One hundred and one patients met inclusion criteria. Overall, most of the patients (81%) had antibiotics longer than recommended with only 3% receiving less than the recommended duration. Median total duration of therapy compared with recommended duration specified in national guidelines was UTI: 10 days [ 7 – 10 ], cUTI: 12 days [7.5-12.5], CAP: 7 days [ 7 – 9 ], HAP: 10 days [ 8 – 12 ]. The median antibiotic duration was shorter in patients with no cultures or culture negative results compared with patients with positive cultures for all indications (UTI: 10.3 vs 10.8 days, cUTI: 9 vs 12 days, CAP: 8 vs 9.1 days, HAP: 10.5 vs 19.8 days). Overall, the recommended duration of antibiotics was completed while inpatient in 34.7%, but varied by infection. More patients with UTI or cUTI completed recommended duration of therapy while inpatient vs for CAP or HAP (53.8% vs 28%, P = .03). Eighty percent of those with UTI, 18.2% with cUTI, 25.6% with CAP, and 31.2% with HAP had already received the recommended duration of treatment, or more, on day of hospital discharge. Conclusions: The median duration of antibiotic therapy for all indications evaluated was longer than recommended in national guidelines. Opportunities for stewardship by non-ID pharmacists to impact postdischarge antimicrobial use at transitions of care have been identified.

scholarly journals 1302. Duration of Antibiotic Therapy for Pneumonia Among Patients with Advanced Cancer: An Opportunity for Antibiotic Stewardship

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S739-S739
Author(s):  
Jemma Benson ◽  
Rupak Datta ◽  
Vincent Quagliarello ◽  
Manisha Juthani-Mehta
Keyword(s):  
Older Adults ◽  
Antibiotic Therapy ◽  
Advanced Cancer ◽  
Antibiotic Stewardship ◽  
Palliative Chemotherapy ◽  
Total Duration ◽  
Index Admission ◽  
Post Discharge ◽  
Duration Of Therapy ◽  
Days Of Therapy

Abstract Background Antibiotic therapy is common for hospitalized older adults (≥65 years) with advanced cancer.1 Pneumonia is prevalent, but data conflict about the benefits and harms of antibiotics in palliative care settings. To inform antibiotic stewardship protocols, we assessed the duration of therapy for non-ventilator-associated pneumonia (non-VAP) in older adults who received palliative chemotherapy for advanced cancer. Methods We identified older adults who received palliative chemotherapy from 1/1/2016 through 9/30/2017 at Yale New Haven Hospital and subsequently developed non-VAP during their index admission following receipt of palliative chemotherapy. Non-VAPs were defined per standardized criteria; 2 complicated pneumonias including those associated with abscess, bacteremia, subsequent VAP, necrotizing and fungal pneumonia, and organizing pneumonia were excluded. We determined the total duration of antibiotics, including both inpatient and post-discharge days of therapy, for each initial episode of non-VAP. Patients were then stratified by total duration of therapy ( >7 days versus ≤ 7 days). Results We identified a total of 118 older adults who developed non-VAP during their index admission following receipt of palliative chemotherapy (Figure). Median age was 77.6 (range, 65.2 to 92.5), 37.2% were female sex, and the most common malignancies included lung (n=42/118; 35.5%), hematologic (n=28/118; 23.7%), gastrointestinal (n=17/118; 14.4%), and genitourinary (n=17/118; 14.4%) tumors. Overall, 83.0% (n=98/118) were prescribed >7 days of therapy. Figure. Duration of therapy for non-VAP Conclusion 83.0% of older adults who developed non-VAP during the index hospitalization following receipt of palliative chemotherapy received a duration of antibiotics that exceeded guideline recommendations. This finding provides an opportunity for intervention to improve patient care and antibiotic stewardship in patients receiving palliative chemotherapy. Future studies are needed in larger cohorts to evaluate the implications of guideline-discordant therapy on readmissions and mortality. References 1. Marra et al. Antibiotic use during end-of-life care: A systematic literature review and meta-analysis. ICHE 2021;42:523-9. 2. CDC NHSN Patient Safety Component Manual, 2021. Disclosures All Authors: No reported disclosures

scholarly journals Inpatient plus Post-discharge Durations of Therapy to Identify Antimicrobial Stewardship Opportunities at Transitions of Care

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S19-S20 ◽  
Author(s):  
April Dyer ◽  
Elizabeth Dodds Ashley ◽  
Deverick J Anderson ◽  
Christina Sarubbi ◽  
Rebekah Wrenn ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Total Duration ◽  
Transitions Of Care ◽  
Electronic Prescribing ◽  
Post Discharge ◽  
Electronic Prescription ◽  
Duration Of Therapy ◽  
National Healthcare Safety Network ◽  
Amoxicillin Clavulanate ◽  
Inpatient Units

Abstract Background In-hospital antimicrobial durations capture only a portion of total antimicrobial exposures attributable to that inpatient stay. Review of electronic discharge prescriptions could allow stewards to identify excessive prescribing durations. Methods We performed a retrospective review of inpatient and discharge antimicrobial prescribing at three hospitals from April to September 2016 using two data sources: electronic medication administrations and electronic prescription orders at discharge. Antimicrobial agents from the National Healthcare Safety Network Antimicrobial Use (NHSN AU) module were included. Durations were calculated for admissions in which patients received at least one dose of an antimicrobial agent on inpatient units. Intended post-discharge durations were captured in days duration fields or calculated from sig and quantity fields of discharge prescriptions. Post-discharge days and inpatient days were summed to calculate the total duration of therapy resulting from the admission. Descriptive statistics were used to describe inpatient, post-discharge, and total durations. Results Among 45,693 inpatient admissions, NHSN AU antimicrobials were given during 23,447 inpatient admissions (51%) and in electronic discharge prescriptions for 7,442 admissions (16%). Median total duration was 4 days (IQR 2–11) among all patients who received antimicrobials and 12 (IQR 9–17) among those who received discharge prescriptions. Common post-discharge durations were 5, 7, and 10 days (Figure 1). Post-discharge days accounted for 40% (78,195/196,792) of the total days of antimicrobial therapy. The most common discharge agents were ciprofloxacin (14%), amoxicillin/clavulanate (11%), and levofloxacin (8%). Most discharge prescriptions originated from medical (37.1%), surgical (15.6%), and hematology/oncology wards (14.5%). Conclusion Post-discharge days accounted for 40% of antimicrobial days related to inpatient admissions. Common post-discharge durations suggested clinicians were not counting inpatient days when completing discharge orders. Post-discharge days were feasibly captured through electronic prescribing records and could aid in targeting stewardship interventions at transitions of care. Disclosures All authors: No reported disclosures.

scholarly journals Procalcitonin-Guided Antibiotic Therapy Reduces Antibiotic Use for Lower Respiratory Tract Infections in a United States Medical Center: Results of a Clinical Trial

2018 ◽  
Vol 5 (12) ◽  
Author(s):  
Jennifer Townsend ◽  
Victoria Adams ◽  
Panagis Galiatsatos ◽  
David Pearse ◽  
Hardin Pantle ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antibiotic Therapy ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
Adverse Outcomes ◽  
Control Group ◽  
Lower Respiratory Tract Infections ◽  
Antibiotic Duration ◽  
Tract Infections

Abstract Background European trials using procalcitonin (PCT)-guided antibiotic therapy for patients with lower respiratory tract infections (LRTIs) have demonstrated significant reductions in antibiotic use without increasing adverse outcomes. Few studies have examined PCT for LRTIs in the United States. Methods In this study, we evaluated whether a PCT algorithm would reduce antibiotic exposure in patients with LRTI in a US hospital. We conducted a controlled pre-post trial comparing an intervention group of PCT-guided antibiotic therapy to a control group of usual care. Consecutive patients admitted to medicine services and receiving antibiotics for LRTI were enrolled in the intervention. Providers were encouraged to discontinue antibiotics according to a PCT algorithm. Control patients were similar patients admitted before the intervention. Results The primary endpoint was median antibiotic duration. Overall adverse outcomes at 30 days comprised death, transfer to an intensive care unit, antibiotic side effects, Clostridium difficile infection, disease-specific complications, and post-discharge antibiotic prescription for LRTI. One hundred seventy-four intervention patients and 200 controls were enrolled. Providers complied with the PCT algorithm in 75% of encounters. Procalcitonin-guided therapy reduced median antibiotic duration for pneumonia from 7 days to 6 (P = .045) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) from 4 days to 3 (P = .01). There was no difference in the rate of adverse outcomes in the PCT and control groups. Conclusions A PCT-guided algorithm safely reduced the duration of antibiotics for treating LRTI. Utilization of a PCT algorithm may aid antibiotic stewardship efforts. This clinical trial was a single-center, controlled, pre-post study of PCT-guided antibiotic therapy for LRTI. The intervention (incorporation of PCT-guided algorithms) started on April 1, 2017: the preintervention (control group) comprised patients admitted from November 1, 2016 to April 16, 2017, and the postintervention group comprised patients admitted from April 17, 2017 to November 29, 2017 (Supplementary Figure 1). The study comprised patients admitted to the internal medicine services to a medical ward, the Medical Intensive Care Unit (MICU), the Cardiac Intensive Care Unit (CICU), or the Progressive Care Unit (PCU) “step down unit”. The registration data for the trails are in the ClinicalTrials.gov database, number NCT0310910.

scholarly journals Urinary tract infections in children: an overview of diagnosis and management

2019 ◽  
Vol 3 (1) ◽  
pp. e000487 ◽  
Author(s):  
Jonathan Kaufman ◽  
Meredith Temple-Smith ◽  
Lena Sanci
Keyword(s):  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Bacterial Infection ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Sample Collection ◽  
Diagnosis And Management ◽  
Duration Of Therapy ◽  
Tract Infections

Urinary tract infections (UTIs) are a common and potentially serious bacterial infection of childhood. History and examination findings can be non-specific, so a urine sample is required to diagnose UTI. Sample collection in young precontinent children can be challenging. Bedside dipstick tests are useful for screening, but urine culture is required for diagnostic confirmation. Antibiotic therapy must be guided by local guidelines due to increasing antibiotic resistance. Duration of therapy and indications for imaging remain controversial topics and guidelines lack consensus. This article presents an overview of paediatric UTI diagnosis and management, with highlights of recent advances and evidence updates.

scholarly journals A Multicenter Stewardship Initiative to Decrease Excessive Duration of Antibiotic Therapy for the Treatment of Community-Acquired Pneumonia (CAP)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S63-S64
Author(s):  
Farnaz Foolad ◽  
Angela Huang ◽  
Cynthia Nguyen ◽  
Lindsay Colyer ◽  
Megan Lim ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Total Duration ◽  
Audit And Feedback ◽  
Patient Specific ◽  
Control Group ◽  
Duration Of Therapy ◽  
The Impact ◽  
Research Grant

Abstract Background Hospitals have implemented multifaceted approaches to quickly identify CAP, start timely therapy, and reduce hospital readmission, yet there has been minimal focus on providing appropriate duration of therapy. The IDSA CAP guidelines recommend 5 days of antibiotic therapy for patients that are clinically stable and quickly defervesce. However, previous publications suggest duration of therapy for CAP may be unnecessarily prolonged. Methods The objective of this multicenter, quasi-experimental study of hospitalized patients with CAP was to assess the impact of a prospective 6-month stewardship intervention on total duration of antibiotic therapy and associated clinical outcomes. All centers updated institutional CAP guidelines to promote IDSA-concordant durations of therapy and provided education to pharmacists and prescribers. Daily patient-specific prospective audit and feedback was provided by infectious diseases stewardship pharmacists to optimize compliance with guideline recommendations. Results A total of 600 patients were included (307 in the historic control group and 293 in the stewardship intervention group). The stewardship intervention led to significantly increased rates of compliance with IDSA duration of therapy recommendations (5.6% vs. 41.4%, P< < 0.01) and significantly reduced the duration of therapy for CAP (9 vs. 6 days, P < 0.01). Inappropriate days of antibiotic therapy was reduced in the intervention group (4 vs. 1.6 days, P < 0.01), and total avoidance of 720 excessive days of antibiotic therapy. Clinical outcomes, including mortality, length of hospitalization, readmission to hospital with pneumonia, presentation to the ER/clinic with pneumonia within 30 days of discharge, and incidence of C. difficilecolitis, were not different between groups. Conclusion This multicenter evaluation of a prospective stewardship intervention in hospitalized CAP patients reduced the total duration of antibiotic therapy and increased compliance with guideline-concordant duration of therapy without adversely affecting patient outcomes. This project was funded through a competitive stewardship grant provided by Merck & Co. Disclosures A. Huang, Merck: Grant Investigator, Research grant; C. Nguyen, Merck: Grant Investigator, Research grant; J. Grieger, Merck: Grant Investigator, Research grant; S. Revolinski, Merck: Grant Investigator, Research grant; J. Li, Merck: Grant Investigator, Research grant; M. Mack, Merck: Grant Investigator, Research grant; J. N. Wainaina, Merck: Grant Investigator, Research grant; G. Eschenauer, Merck: Grant Investigator, Research grant; T. Patel, Merck: Grant Investigator, Research grant; V. Marshall, Merck: Grant Investigator, Research grant; J. Nagel, Merck: Grant Investigator, Research grant

scholarly journals The Characteristics of Children with UTI Due to ESBL-producing Bacteria at Dr. Soetomo General Hospital, Surabaya

2021 ◽  
Vol 4 (1) ◽  
pp. 38
Author(s):  
Ida Fitriawati ◽  
Manik Retno Wahyunitisari ◽  
Risky Vitria Prasetyo ◽  
Dwiyanti Puspitasari
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antibiotic Therapy ◽  
General Hospital ◽  
Clinical Characteristics ◽  
Total Duration ◽  
High Fever ◽  
Empiric Antibiotic Therapy ◽  
Tract Infections

Introduction: Urinary tract infection (UTI) by extended-spectrum beta-lactamase-producing bacteria often results in a delay in obtaining appropriate antibiotics. The information on patients’ clinical characteristics is necessary for early recognition and the selection of empiric antibiotic therapy. This study aims to investigate the clinical characteristics and the length of therapy of patients with urinary tract infections by those resistant bacteria.Method: This study utilizes a cross-sectional design. Medical records of hospitalized children aged 1-18 months with UTI due to ESBL-producing bacteria at Dr. Soetomo general hospital between January 1, 2017 - July 20, 2020, were reviewed retrospectively. Variables of interest were the demographic data, underlying diseases, causative organism, clinical presentation, maximal body temperature, and length of antibiotic therapy.Results: Among 37 patients enrolled, 25 patients were female. The incidence of urinary tract infection in children was dominated by age 1-12 months old (37.8%). Urological abnormalities were presented in 62.2% of patients. ESBL-producing Escherichia coli was the most common isolated uropathogen (62.2%). High fever was found in 10/28 patients (35.7%). In 17 patients (45.9%), the total duration of antibiotic therapy was 8-14 days.Conclusion: In children with UTI, especially in the infant group, who had urological abnormality or present with a high fever, and who do not respond to empiric therapy should be suspected of developing UTI due to ESBL-producing bacteria.

The Five Ds of Outpatient Antibiotic Stewardship for Urinary Tract Infections

2021 ◽  
Author(s):  
Melanie C. Goebel ◽  
Barbara W. Trautner ◽  
Larissa Grigoryan
Keyword(s):  
Primary Care ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Emergency Departments ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Outpatient Clinics ◽  
Tract Infections

Urinary tract infections (UTI) are one of the most common indications for antibiotic prescriptions in the outpatient setting. Given rising rates of antibiotic resistance among uropathogens, antibiotic stewardship is critically needed to improve outpatient antibiotic use, including in outpatient clinics (primary care and specialty clinics) and emergency departments.

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.

scholarly journals Multistep antimicrobial stewardship intervention on antibiotic prescriptions and treatment duration in children with pneumonia

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0257993
Author(s):  
Sara Rossin ◽  
Elisa Barbieri ◽  
Anna Cantarutti ◽  
Francesco Martinolli ◽  
Carlo Giaquinto ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Clinical Pathways ◽  
Community Acquired Pneumonia ◽  
Broad Spectrum Antibiotics ◽  
Outpatient Group ◽  
Before And After ◽  
Tract Infections ◽  
The Impact

Introduction The Italian antimicrobial prescription rate is one of the highest in Europe, and antibiotic resistance has become a serious problem with high costs and severe consequences, including prolonged illnesses, the increased period of hospitalization and mortality. Inadequate antibiotic prescriptions have been frequently reported, especially for lower respiratory tract infections (LRTI); many patients receive antibiotics for viral pneumonia or bronchiolitis or broad-spectrum antibiotics for not complicated community-acquired pneumonia. For this reason, healthcare organizations need to implement strategies to raise physicians’ awareness about this kind of drug and their overall effect on the population. The implementation of antibiotic stewardship programs and the use of Clinical Pathways (CPs) are excellent solutions because they have proven to be effective tools at diagnostic and therapeutic levels. Aims This study evaluates the impact of CPs implementation in a Pediatric Emergency Department (PED), analyzing antibiotic prescriptions before and after the publication in 2015 and 2019. The CP developed in 2019 represents an update of the previous one with the introduction of serum procalcitonin. The study aims to evaluate the antibiotic prescriptions in patients with community-acquired pneumonia (CAP) before and after both CPs (2015 and 2019). Methods The periods analyzed are seven semesters (one before CP-2015 called PRE period, five post CP-2015 called POST 1–5 and 1 post CP-2019 called POST6). The patients have been split into two groups: (i) children admitted to the Pediatric Acute Care Unit (INPATIENTS), and (ii) patients evaluated in the PED and sent back home (OUTPATIENTS). We have analyzed all descriptive diagnosis of CAP (the assessment of episodes with a descriptive diagnosis were conducted independently by two pediatricians) and CAP with ICD9 classification. All antibiotic prescriptions for pediatric patients with CAP were analyzed. Results A drastic reduction of broad-spectrum antibiotics prescription for inpatients has been noticed; from 100.0% in the PRE-period to 66.7% in POST1, and up to 38.5% in POST6. Simultaneously, an increase in amoxicillin use from 33.3% in the PRE-period to 76.1% in POST1 (p-value 0.078 and 0.018) has been seen. The outpatients’ group’s broad-spectrum antibiotics prescriptions decreased from 54.6% PRE to 17.4% in POST6. Both for outpatients and inpatients, there was a decrease of macrolides. The inpatient group’s antibiotic therapy duration decreased from 13.5 days (PRE-period) to 7.0 days in the POST6. Antibiotic therapy duration in the outpatient group decreased from 9.0 days (PRE) to 7.0 days (POST1), maintaining the same value in subsequent periods. Overlapping results were seen in the ICD9 group for both inpatients and outpatients. Conclusions This study shows that CPs are effective tools for an antibiotic stewardship program. Indeed, broad-spectrum antibiotics usage has dropped and amoxicillin prescriptions have increased after implementing the CAP CP-2015 and the 2019 update.

scholarly journals 146. Predictors of Long Duration Antibiotic Therapy for Urinary Tract Infections and Community-Acquired Pneumonia in Pediatric Ambulatory Care Settings

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S185-S185
Author(s):  
Rohan M Shah ◽  
Shan Sun ◽  
Tonya Scardina ◽  
Sameer Patel
Keyword(s):  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Ambulatory Care ◽  
Community Acquired Pneumonia ◽  
Primary Language ◽  
Duration Of Therapy ◽  
Long Duration ◽  
Younger Age ◽  
Prolonged Duration ◽  
Tract Infections

Abstract Background Significant variation exists in the duration of antibiotic therapy for children in ambulatory care settings. Understanding drivers of variation for common conditions such as community-acquired pneumonia (CAP) and urinary tract infection (UTI) is important to informing antimicrobial stewardship interventions. Methods A retrospective observational study was conducted of patients with CAP and UTI seen in outpatient clinics or discharged from the emergency room (ER) of a tertiary care children’s hospital network from 2016 – 2019. Diagnoses CAP and UTI were identified via ICD-10 coding. Only oral medications ordered for ≥ 3 and < 28 days were included. Multivariable logistic regression was performed to identify predictors of long antibiotic duration (defined as ≥ 10 days). Potential non-clinical drivers of longer duration included race, ethnicity, sex, primary language, and insurance status. Results A total of 2,104 prescriptions for CAP from 442 prescribers and 1,070 prescriptions for UTI from 314 prescribers were included. Antibiotic durations were ≥ 10 days in 59.9% and 47.6% of prescriptions for CAP and UTI, respectively. Long duration of therapy was more common in children discharged from the ER when compared to clinics for both CAP (OR 1.795, 95% CI: 1.107 - 2.929), and UTI (OR 5.149, 95% CI: 1.933 - 16.373). The proportion of patients with long duration of therapy increased with younger age for both diagnoses and decreased overall in the final year of the study. Race, gender, ethnicity, and primary language were not associated with prolonged duration of therapy. However, patients with Medicaid insurance were more likely to receive long duration of therapy for CAP (OR 1.337, 95% CI: 1.062 - 1.682) and UTI (1.654, 95%, CI: 1.181 - 2.325). Conclusion In pediatric patients in ambulatory care settings, younger age, care in the ER, and being insured through Medicaid were independently associated with prolonged duration of therapy for both UTI and CAP. Disclosures All Authors: No reported disclosures

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