Impact of an antimicrobial stewardship intervention on antibiotic
prescribing practices for community-acquired acute uncomplicated cystitis in the emergency department

BACKGROUND: In the emergency department (ED) acute cystitis is often treated empirically. It is recommended that fluoroquinolones (FQs) be reserved for those who do not have alternative treatment options. The purpose of this study was to assess an antimicrobial stewardship intervention on prescribing practices for community-acquired acute uncomplicated cystitis in the ED. METHODS: A controlled quasi-experimental antimicrobial stewardship education and quality improvement intervention study in the ED consisting of three phases: (1) pre-intervention- historical data collection (7 months), (2) pharmacists’ provision of provider education (2 months), and (3) post-intervention observational data collection (7 months). Patients included were >18 years of age with diagnosis of acute uncomplicated cystitis in the ED and urine culture positive for E. coli. Patients were excluded if diagnosed with pyelonephritis, received intravenous antibiotics, or treated for healthcare-associated infection. The primary outcome was incidence of FQ prescriptions before-and-after the antimicrobial stewardship intervention. Secondary outcomes were incidence of E. coli susceptibility to empiric treatment, ED specific treatment algorithm adherence, and 30-day revisit to the ED. Chi-square and Fisher’s exact statistical tests were used to analyze outcomes. RESULTS: The study included 174 patients, 90 in the pre-intervention and 84 in the post-intervention groups. Patients were predominantly young African-American females. Upon provision of pharmacists’ education, empiric FQ prescribing for acute uncomplicated cystitis decreased from 38.9% to 13.1%, pre and post-intervention, respectively (P < 0.001). Adherence to the ED specific antibiogram and treatment algorithm improved from 35.6% to 74% in the pre and post-intervention groups, respectively (P < 0.001). There was no difference pre and post-intervention for incidence of E. coli susceptibility to empiric antimicrobial treatment and 30-day revisit to the ED. CONCLUSION: An antimicrobial stewardship intervention in the ED significantly reduced fluoroquinolone use for the treatment of acute uncomplicated cystitis and increased adherence to acute uncomplicated cystitis treatment guidelines. DISCLOSURES: All authors: No reported disclosures.