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45. Antimicrobial Stewardship for Urinary Tract Infection in Three Emergency Departments Across a Health System

BACKGROUND: Broad spectrum antibiotics are often prescribed to patients presenting to the emergency department (ED) for evaluation of urinary tract infection and pyelonephritis (UTI). We evaluated the effect of a target-specific antibiogram, education, and feedback on UTI diagnosis and antibiotic pr...

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Autores principales: Shoff, Christopher, Funaro, Jason, Fischer, Kristen M, Boreyko, John, Shroba, Jenny, Mando-Vandrick, Jennifer, Liu, Beiyu, Lee, Hui-Jie, Spires, Steven S, Turner, Nicholas A, Theophanous, Rebecca, Staton, Catherine, Moehring, Rebekah W, Wrenn, Rebekah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777005/
http://dx.doi.org/10.1093/ofid/ofaa439.090
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author Shoff, Christopher
Funaro, Jason
Fischer, Kristen M
Boreyko, John
Shroba, Jenny
Mando-Vandrick, Jennifer
Liu, Beiyu
Lee, Hui-Jie
Spires, Steven S
Turner, Nicholas A
Theophanous, Rebecca
Staton, Catherine
Moehring, Rebekah W
Wrenn, Rebekah
author_facet Shoff, Christopher
Funaro, Jason
Fischer, Kristen M
Boreyko, John
Shroba, Jenny
Mando-Vandrick, Jennifer
Liu, Beiyu
Lee, Hui-Jie
Spires, Steven S
Turner, Nicholas A
Theophanous, Rebecca
Staton, Catherine
Moehring, Rebekah W
Wrenn, Rebekah
author_sort Shoff, Christopher
collection PubMed
description BACKGROUND: Broad spectrum antibiotics are often prescribed to patients presenting to the emergency department (ED) for evaluation of urinary tract infection and pyelonephritis (UTI). We evaluated the effect of a target-specific antibiogram, education, and feedback on UTI diagnosis and antibiotic prescribing in this setting. METHODS: We created a urine-specific antibiogram from patients seen and treated without admission at three ED locations (one academic and two community hospitals). We then provided a treatment algorithm and supplemental educational content to ED providers in November 2019. Educational content highlighted appropriate diagnosis, antibiotic selection, and treatment duration for UTI. Adult encounters with appropriate ICD-9/10 codes within twelve months prior to content delivery comprised the preintervention cohort. The postintervention cohort consisted of adult visits following educational intervention until April 17, 2020. During the postintervention phase (November 2019 to April 2020), summary data regarding UTI diagnoses and guideline-concordant prescriptions were fed back routinely to ED providers through email. Guideline-concordant prescriptions were defined as those adhering to first or second-line therapy in the treatment algorithm. The proportion of prescriptions meeting this definition fulfilled the primary outcome. An interrupted time series analysis measured changes in guideline concordance. RESULTS: Data from 6,713 distinct encounters were analyzed across the three sites. While guideline concordant prescribing increased following intervention at all locations (30.9% to 38.8%, 48.1% to 49.1%, and 48.2% to 59.6%), these increases were not statistically significant (Figures 1, 2, and 3). The proportion of all ED encounters with a UTI diagnosis did not differ following the intervention. Interestingly, guideline concordance was greater in the academic ED, compared to the community hospitals. [Image: see text] [Image: see text] [Image: see text] CONCLUSION: Although guideline concordant prescribing for UTI increased in all three ED settings with education and email correspondence feedback, these results were not statistically significant. A variety of methods may be required to realize improved antibiotic prescribing across a diverse group of clinicians. DISCLOSURES: Rebekah W. Moehring, MD, MPH, Agency for Healthcare Quality and Research (Grant/Research Support)Centers for Disease Control and Prevention (Grant/Research Support)
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spelling pubmed-77770052021-01-07 45. Antimicrobial Stewardship for Urinary Tract Infection in Three Emergency Departments Across a Health System Shoff, Christopher Funaro, Jason Fischer, Kristen M Boreyko, John Shroba, Jenny Mando-Vandrick, Jennifer Liu, Beiyu Lee, Hui-Jie Spires, Steven S Turner, Nicholas A Theophanous, Rebecca Staton, Catherine Moehring, Rebekah W Wrenn, Rebekah Open Forum Infect Dis Poster Abstracts BACKGROUND: Broad spectrum antibiotics are often prescribed to patients presenting to the emergency department (ED) for evaluation of urinary tract infection and pyelonephritis (UTI). We evaluated the effect of a target-specific antibiogram, education, and feedback on UTI diagnosis and antibiotic prescribing in this setting. METHODS: We created a urine-specific antibiogram from patients seen and treated without admission at three ED locations (one academic and two community hospitals). We then provided a treatment algorithm and supplemental educational content to ED providers in November 2019. Educational content highlighted appropriate diagnosis, antibiotic selection, and treatment duration for UTI. Adult encounters with appropriate ICD-9/10 codes within twelve months prior to content delivery comprised the preintervention cohort. The postintervention cohort consisted of adult visits following educational intervention until April 17, 2020. During the postintervention phase (November 2019 to April 2020), summary data regarding UTI diagnoses and guideline-concordant prescriptions were fed back routinely to ED providers through email. Guideline-concordant prescriptions were defined as those adhering to first or second-line therapy in the treatment algorithm. The proportion of prescriptions meeting this definition fulfilled the primary outcome. An interrupted time series analysis measured changes in guideline concordance. RESULTS: Data from 6,713 distinct encounters were analyzed across the three sites. While guideline concordant prescribing increased following intervention at all locations (30.9% to 38.8%, 48.1% to 49.1%, and 48.2% to 59.6%), these increases were not statistically significant (Figures 1, 2, and 3). The proportion of all ED encounters with a UTI diagnosis did not differ following the intervention. Interestingly, guideline concordance was greater in the academic ED, compared to the community hospitals. [Image: see text] [Image: see text] [Image: see text] CONCLUSION: Although guideline concordant prescribing for UTI increased in all three ED settings with education and email correspondence feedback, these results were not statistically significant. A variety of methods may be required to realize improved antibiotic prescribing across a diverse group of clinicians. DISCLOSURES: Rebekah W. Moehring, MD, MPH, Agency for Healthcare Quality and Research (Grant/Research Support)Centers for Disease Control and Prevention (Grant/Research Support) Oxford University Press 2020-12-31 /pmc/articles/PMC7777005/ http://dx.doi.org/10.1093/ofid/ofaa439.090 Text en © The Author 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Poster Abstracts
Shoff, Christopher
Funaro, Jason
Fischer, Kristen M
Boreyko, John
Shroba, Jenny
Mando-Vandrick, Jennifer
Liu, Beiyu
Lee, Hui-Jie
Spires, Steven S
Turner, Nicholas A
Theophanous, Rebecca
Staton, Catherine
Moehring, Rebekah W
Wrenn, Rebekah
45. Antimicrobial Stewardship for Urinary Tract Infection in Three Emergency Departments Across a Health System
title 45. Antimicrobial Stewardship for Urinary Tract Infection in Three Emergency Departments Across a Health System
title_full 45. Antimicrobial Stewardship for Urinary Tract Infection in Three Emergency Departments Across a Health System
title_fullStr 45. Antimicrobial Stewardship for Urinary Tract Infection in Three Emergency Departments Across a Health System
title_full_unstemmed 45. Antimicrobial Stewardship for Urinary Tract Infection in Three Emergency Departments Across a Health System
title_short 45. Antimicrobial Stewardship for Urinary Tract Infection in Three Emergency Departments Across a Health System
title_sort 45. antimicrobial stewardship for urinary tract infection in three emergency departments across a health system
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777005/
http://dx.doi.org/10.1093/ofid/ofaa439.090
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