Evaluating the Need for Antimicrobial Stewardship Efforts in the Outpatient Setting: A Focus on Appropriate Prescribing for Urinary Tract Infections

IDWEEK 2015 POSTER ABSTRACTS 158. Evaluating the Need for Antimicrobial Stewardship Efforts in the Outpatient Setting: A Focus on Appropriate Prescribing for Urinary Tract Infections Liberty Dykehouse, MSN, RN, ACNS-BC, CIC1; Lisa Dumkow, PharmD, BCPS2; Andrew Jameson, MD3; 1Infection Control, Mercy Health Saint Mary’s, Grand Rapids, Michigan; 2Pharmaceutical Services, Mercy Health Saint Mary’s, Grand Rapids, Michigan; 3Infectious Diseases, Mercy Health Saint Mary’s, Grand Rapids, Michigan Session: 42. Antimicrobial Stewardship: Current State and Future Opportunities Thursday, October 8, 2015: 12:30 PM Background. Increasing antimicrobial resistance is a major threat to public health. Antimicrobial stewardship programs (ASPs) have shown to reduce antimicrobial utilization and resistance, improve patient outcomes, and decrease healthcare-associated infections. Most ASPs target antimicrobial use in the acute care setting, however, the bulk of antimicrobial prescribing occurs at ambulatory care sites making these a critical target for ASPs. We describe a baseline needs assessment for antimicrobial stewardship efforts focused on appropriate diagnosis and prescribing for urinary tract infections (UTIs) at ambulatory care sites. Methods. A retrospective cohort study was conducted of adult patients treated at three ambulatory care sites providing express care between 1 January 2014 and 30 September 2014 to assess guideline-concordant prescribing (GCP) of empiric therapy for UTIs. Patients were eligible for inclusion if they had a diagnosis of dysuria, pyuria, cystitis, pyelonephritis or asymptomatic bacteriuria. Patients were excluded if they were pregnant, neutropenic, or had a history of renal transplant. Data collected included patient and diagnostic characteristics, appropriateness of therapy, and patient outcomes including office revisits within 30 days and adverse effects. Therapy was considered GCP if it met national and local health system guidelines for empiric therapy based on drug selection, dose, and duration of therapy. Results. A total of 1838 patients were eligible for the study; 388 patients were randomly selected for inclusion. Patients were mostly female (91.2%) with an average age of 50 ± 18 years. Three hundred seventy-six patients (96.9%) had a dipstick urinalysis performed in the outpatient office while 249 (64.2%) had a urine culture performed. Escherichia coli was the most commonly identified organism, n = 109 (43.7%), whereas 95 patients (38.1%) had a negative culture. Two hundred ninety-four (75.8%) patients received antimicrobial therapy. Ciprofloxacin was the most commonly prescribed antibiotic (33.3%), followed by sulfamethoxazole/trimethoprim (29.4%), and nitrofurantoin (12.9%). Total GCP was achieved in only 28.6% (n = 111) of cases with only 31% of patient receiving the most appropriate drug. Conclusion. This study supports the need for outpatient ASP interventions targeting appropriate UTI diagnosis and prescribing. Disclosures. All authors: No reported disclosures. Open Forum Infectious Diseases 2015;2:71–536 © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. 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 . DOI: 10.1093/ofid/ofv133 Poster Abstracts • OFID 2015:2 (Suppl 1) • S71  (...truncated)