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1337. An Outpatient Antimicrobial Stewardship Initiative for Urinary Tract Infections in Primary Care Pediatrics

BACKGROUND: Studies have showed that 30% of antibiotics prescribed in the outpatient setting are unnecessary. Acute UTI constitutes a significant health burden in outpatient pediatrics affecting ~2.8% of children every year. Antibiotics are often started empirically when diagnosing UTI making pediat...

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Autores principales: Mannix, Mary Kathryn, Islam, Shamim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777253/
http://dx.doi.org/10.1093/ofid/ofaa439.1519
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author Mannix, Mary Kathryn
Islam, Shamim
author_facet Mannix, Mary Kathryn
Islam, Shamim
author_sort Mannix, Mary Kathryn
collection PubMed
description BACKGROUND: Studies have showed that 30% of antibiotics prescribed in the outpatient setting are unnecessary. Acute UTI constitutes a significant health burden in outpatient pediatrics affecting ~2.8% of children every year. Antibiotics are often started empirically when diagnosing UTI making pediatric UTIs an ideal target for outpatient stewardship. The primary objective was to reduce the use of broad-spectrum empiric antibiotics with a secondary objective to study antibiotic discontinuation in culture negative cases. METHODS: The electronic medical records of two pediatric practices were screened for patients aged 2 months to 18 years diagnosed with uncomplicated UTI using ICD-10 codes N39, R30 and R35. The definition of a positive urine culture was > 50,000 CFU/ml if catheterized and > 100,000 CFU/ml if clean-catch specimen. A two-year pre-intervention period began in January 2018. An audit and review of urine culture processes were studied at each site with a subsequent educational intervention, a direct, one-hour session focused on the use of cephalexin as first-line empiric therapy based on the local antibiogram. The post-intervention period began at each site after the intervention. A COVID-19 sub-analysis was performed for the post-intervention period. RESULTS: During the study, 515 encounters and 113 encounters were included during the pre- and post-intervention periods, respectively. 74.4% (383/515) of pre-intervention encounters had empirically prescribed antibiotics; higher-generation cephalosporins (i.e. cefdinir, cefprozil) most frequently. Antibiotics were empirically prescribed in 75.2% (85/113) of post-intervention encounters with a statistically significant increase in cephalexin use (32/85, 37.6%, p < 0.01) and reduction in higher-generation cephalosporin use (p < 0.01), Figure 1. In the COVID-19 analysis, empiric antibiotic prescribing trended towards baseline as providers were relying largely on telemedicine, Figure 2. Figure 1: Empiric Antibiotic Prescribing Pre- and Post-InterventionF [Image: see text] Figure 2: Empiric Antibiotic Prescribing - % [Image: see text] Table 1: Pre- and Post-Intervention [Image: see text] CONCLUSION: The educational intervention was effective in changing antibiotic prescribing with an increased use of narrow spectrum antibiotics. This change waned without reinforcement and reliance on telemedicine during COVID-19. Antibiotic discontinuation in culture-negative cases remains an important area for improvement. DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-77772532021-01-07 1337. An Outpatient Antimicrobial Stewardship Initiative for Urinary Tract Infections in Primary Care Pediatrics Mannix, Mary Kathryn Islam, Shamim Open Forum Infect Dis Poster Abstracts BACKGROUND: Studies have showed that 30% of antibiotics prescribed in the outpatient setting are unnecessary. Acute UTI constitutes a significant health burden in outpatient pediatrics affecting ~2.8% of children every year. Antibiotics are often started empirically when diagnosing UTI making pediatric UTIs an ideal target for outpatient stewardship. The primary objective was to reduce the use of broad-spectrum empiric antibiotics with a secondary objective to study antibiotic discontinuation in culture negative cases. METHODS: The electronic medical records of two pediatric practices were screened for patients aged 2 months to 18 years diagnosed with uncomplicated UTI using ICD-10 codes N39, R30 and R35. The definition of a positive urine culture was > 50,000 CFU/ml if catheterized and > 100,000 CFU/ml if clean-catch specimen. A two-year pre-intervention period began in January 2018. An audit and review of urine culture processes were studied at each site with a subsequent educational intervention, a direct, one-hour session focused on the use of cephalexin as first-line empiric therapy based on the local antibiogram. The post-intervention period began at each site after the intervention. A COVID-19 sub-analysis was performed for the post-intervention period. RESULTS: During the study, 515 encounters and 113 encounters were included during the pre- and post-intervention periods, respectively. 74.4% (383/515) of pre-intervention encounters had empirically prescribed antibiotics; higher-generation cephalosporins (i.e. cefdinir, cefprozil) most frequently. Antibiotics were empirically prescribed in 75.2% (85/113) of post-intervention encounters with a statistically significant increase in cephalexin use (32/85, 37.6%, p < 0.01) and reduction in higher-generation cephalosporin use (p < 0.01), Figure 1. In the COVID-19 analysis, empiric antibiotic prescribing trended towards baseline as providers were relying largely on telemedicine, Figure 2. Figure 1: Empiric Antibiotic Prescribing Pre- and Post-InterventionF [Image: see text] Figure 2: Empiric Antibiotic Prescribing - % [Image: see text] Table 1: Pre- and Post-Intervention [Image: see text] CONCLUSION: The educational intervention was effective in changing antibiotic prescribing with an increased use of narrow spectrum antibiotics. This change waned without reinforcement and reliance on telemedicine during COVID-19. Antibiotic discontinuation in culture-negative cases remains an important area for improvement. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2020-12-31 /pmc/articles/PMC7777253/ http://dx.doi.org/10.1093/ofid/ofaa439.1519 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
Mannix, Mary Kathryn
Islam, Shamim
1337. An Outpatient Antimicrobial Stewardship Initiative for Urinary Tract Infections in Primary Care Pediatrics
title 1337. An Outpatient Antimicrobial Stewardship Initiative for Urinary Tract Infections in Primary Care Pediatrics
title_full 1337. An Outpatient Antimicrobial Stewardship Initiative for Urinary Tract Infections in Primary Care Pediatrics
title_fullStr 1337. An Outpatient Antimicrobial Stewardship Initiative for Urinary Tract Infections in Primary Care Pediatrics
title_full_unstemmed 1337. An Outpatient Antimicrobial Stewardship Initiative for Urinary Tract Infections in Primary Care Pediatrics
title_short 1337. An Outpatient Antimicrobial Stewardship Initiative for Urinary Tract Infections in Primary Care Pediatrics
title_sort 1337. an outpatient antimicrobial stewardship initiative for urinary tract infections in primary care pediatrics
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777253/
http://dx.doi.org/10.1093/ofid/ofaa439.1519
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