1517. Evaluation of Antibiotic Prescribing Practices for Lower Urinary Tract Infections in the Emergency Department

BACKGROUND: Evaluation of antibiotic prescribing practices in the emergency department (ED) for urinary tract infections (UTI) is needed given new accreditation standards for outpatient antimicrobial stewardship. Prescribing practices in the ED for UTIs have not been well defined. We aimed to describe the prescribing patterns for UTIs among varied provider types in the ED, with the goal of targeting interventions to minimize the use of broad-spectrum antibiotics and avoid unnecessarily long antibiotic durations. METHODS: This retrospective, single-center study included adults presenting to the ED and discharged home from September 2015 through August 2017 with a primary diagnosis of UTI. Included patients had a diagnosis of a lower tract UTI (ICD-10 codes for acute cystitis (N30) and cystitis with or without hematuria (N30.90–91)). Excluded patients were not prescribed antibiotics or had an additional ICD-10 code for pyelonephritis (N10). Data from the electronic health record was used to categorize patients as uncomplicated or complicated. Allergies, recent antibiotic use and prior urine cultures were utilized when determining compliance with first-line (nitrofurantoin or fosfomycin) and second-line (cephalexin or trimethoprim/sulfamethoxazole (TMP/SMX)) recommendations. The primary objective was to describe prescriber compliance with institutional UTI guidelines for both drug selection and duration. RESULTS: Of 658 UTI encounters included, the compliance rate for both appropriate drug selection and duration was 11.6%, with lower compliance to drug selection (17.6%) compared with duration (58.2%). The most commonly prescribed antibiotics included: cephalexin, TMP/SMX, and ciprofloxacin. Fluoroquinolones (FQs) comprised 24.2% of all antibiotics prescribed, yet only 2% were appropriate. Patients with uncomplicated UTIs had a lower compliance rate to appropriate drug duration compared with complicated UTIs (40.9% vs. 77.5%, P < 0.001). No difference in outcomes were observed. CONCLUSION: In the ED, both appropriate drug selection and duration for UTIs are low. Excessive durations of therapy and higher rates of FQs were common. Stewardship efforts in the ED should target both appropriate drug selection and duration as well as de-emphasize FQ use. DISCLOSURES: All authors: No reported disclosures.