Antimicrobial Stewardship Program Intervention Package for Increasing Appropriate Outpatient Antibiotic Usage: A Clinic-Feedback Based Approach

BACKGROUND: The National Action Plan for Combating Antibiotic-Resistant Bacteria issued in March 2015 advocates for the presence of Antimicrobial Stewardship Programs (ASPs) in all outpatient settings by 2020 with a 50% reduction in inappropriate outpatient antibiotics. The purpose of this initiative is to determine whether ASP intervention can reduce prescription of antibiotics commonly associated with UTI treatment. METHODS: A prospective cohort quality improvement initiative at Ralph H. Johnson VAMC evaluated the number of prescriptions written by primary care providers in Clinic A and Clinic B for oral antibiotics commonly associated with UTI treatment. Historical control data were collected from October 2015 - December 2015 and active ASP intervention data from October 2016 - December 2016. ASP interventions included: routine face-to-face provider education, clinic-specific feedback in the form of monthly e-mailed report cards, UTI treatment order menu implementation, modification of in-clinic antibiotic availability, and provision of pocket antibiograms. E. coli isolates and susceptibilities were also assessed for both time periods. RESULTS: Clinic A demonstrated a 34% reduction in the number of prescriptions for antibiotics commonly associated with UTI treatment when comparing historical control data to ASP intervention data (126 vs. 70 prescriptions, respectively); Clinic B had a 19% increase (106 vs. 132 prescriptions). Clinic A had a 46% reduction in prescriptions written for fluoroquinolones (70 vs. 38 prescriptions); Clinic B had a 15% reduction (53 vs. 45 prescriptions). Total number of E. coli isolates decreased (143 vs. 131 isolates). E. coli susceptibilities to locally recommended first-line antibiotics increased, including amoxicillin/clavulanate (78% to 85%) and sulfamethoxazole-trimethoprim susceptibilities (73% to 81%); susceptibilities to ciprofloxacin also increased (71% to 79%). CONCLUSION: Combining multiple outpatient ASP interventions to improve antibiotic prescribing can successfully reduce the total number of antibiotic prescriptions commonly written for UTI treatment. An ASP outpatient UTI treatment intervention package was most effective at reducing the total number of prescriptions written for fluoroquinolones. DISCLOSURES: All authors: No reported disclosures.