Partners in Stewardship: Collaboration Between a Tertiary Hospital and Local Skilled Nursing Facilities to Improve Management of Suspected Urinary Tract Infections

BACKGROUND: Opportunities exist for improving antimicrobial use in skilled nursing facilities (SNF). We evaluated the impact of a tertiary medical center partnering with local SNFs to improve appropriate diagnosis and antimicrobial utilization focused on management of suspected urinary tract infections (UTIs). METHODS: Using an existing collaboration between Cedars-Sinai Medical Center and 8 SNFs, we established a framework of antimicrobial stewardship principles related to UTI management as follows: Phase 1 (Jul-Dec 2015), baseline assessment; Phase 2 (January-Jun 2016), developed SNF-specific UTI treatment recommendations based on local resistance patterns; Phase 3 (Jul-Dec 2016), implemented tools to standardize UTI assessment, including SNF-specific treatment recommendations developed in Phase 2. Outcome assessments included antimicrobial utilization and prescribing consistent with treatment recommendations. Chi-squared and Student’s t-test were used as appropriate. RESULTS: Aggregate data were available from 3 SNFs. Compared with baseline, implementation of the program was associated with a 20% reduction in monthly antimicrobial days of therapy (DOT) (181 to 144 DOT/1000 patient days, P = 0.04), including a 39% reduction in fluoroquinolone (FQ) DOT (37 to 22 DOT/1000 patient days, P = 0.002). Initiation of FQ orders declined by 41% (17 to 10 orders/month, P = 0.02). Following implementation, 60% of antimicrobial orders for UTI were consistent with SNF-specific UTI guideline recommendations. We continued to observe a high proportion of patients without UTI symptoms who received antimicrobials (72%). Additional data were available from one facility. Initiation of antimicrobials at the SNF for UTIs decreased 29% (75 to 53 orders/month, P < 0.001), and SNF FQ orders for UTIs decreased 55% (11 to 5 orders/month, P = 0.005). CONCLUSION: Hospitals and SNFs can partner to develop a successful antimicrobial stewardship program. Implementing facility-specific tools to guide appropriate management of suspected UTI was associated with a significant reduction in overall antimicrobial prescribing, particularly FQs. Opportunities to reduce overtreatment for asymptomatic bacteriuria remain. DISCLOSURES: All authors: No reported disclosures.