1113. Outpatient Antimicrobial Stewardship: Targets for Urinary Tract Infections

BACKGROUND: Urinary tract infections (UTIs) remain one of the most commonly diagnosed infectious diseases in the United States in both the inpatient and outpatient settings, accounting for 10.5 million outpatient visits in 2007. Of these visits, 5.4 million were seen in primary care offices. Outpatient antimicrobial stewardship programs are emerging and a focused approach to UTIs is needed to help guide new programs. METHODS: Data were collected by retrospective chart review of outpatient males at the VA Western New York Healthcare System using encounters from January 2005 to March 2018. Appropriate treatment was defined as antimicrobial prescribing in the setting of at least 2 signs/symptoms of UTI. Categorical data were analyzed using the chi-square test and continuous data using the Student t-test. Factors that differed significantly (P < 0.05) between the comparator groups were built into a multivariate logistic regression model to determine factors associated with inappropriate prescribing, which were presented as an Odds Ratio (OR) and 95% Confidence Interval (CI). RESULTS: A total of 607 outpatients met criteria for inclusion, of which 40% were treated inappropriately. Of the 60% treated appropriately (therapy was indicated and empiric drug choice was correct), 95% of patients received a correct dose and 57% received an appropriate duration. Several risk factors were identified for inappropriate prescribing. Female patients were more likely to be treated inappropriately, OR 4.7 (95% CI, 2.4–9.1). Patients with a higher Charlson Comorbidity Index of 5–10 were 2.9 times more likely to be treated inappropriately (95% CI, 1.8–5.0). Those patients who received a urine culture or imaging were more likely to be treated appropriately: OR 0.6 (95% CI, 0.4–0.9) and 0.5 (95% CI, 0.3–0.7), respectively. CONCLUSION: Outpatient antibiotic prescribing for UTIs is suboptimal. Outpatient stewardship programs may wish to educate providers on symptoms of UTI. Interestingly, those with signs and symptoms consistent with UTI were more likely to have a urine culture and/or imaging completed suggesting that providers were aware of a true diagnosis of a UTI. Stewardship programs should pay special attention to patients with numerous comorbidities as they are often inappropriately treated. DISCLOSURES: All authors: No reported disclosures.