A multifaceted antibiotic stewardship program increased the use of guideline-concordant antibiotics for patients admitted to the emergency department (ED) with urinary tract infections (UTI), according to results of a study published in Clinical Infectious Diseases.

This prospective quasi-experimental study was conducted at 1 community and 2 academic hospitals in North Carolina. A multidisciplinary team of clinicians designed an ED-specific guideline for appropriate antibiotic use for patients with UTIs admitted to the ED. Resident clinicians attended educational sessions and received feedback about guideline concordance. Patients (N=8742) diagnosed with acute cystitis or pyelonephritis between 2018 and 2021 were assessed for guideline-concordant antibiotic use. The study comprised a baseline period (phase zero) followed by 2 intervention phases. Phase 1 involved the implementation of ED-specific urine antibiograms and UTI treatment guidelines, education, and feedback on UTI diagnoses and antibiotic treatment, and phase 2 involved re-education and clinician feedback. The primary outcome of guideline-concordant antibiotic use was assessed via interrupted time series regression analysis with 2-week intervals.

Among patients admitted to the ED in phases zero (n=5023), 1 (n=3454), and 2 (n=1949) of the study, the mean ages were 47.6, 47.9, and 49.2 years; 77.8%, 75.5%, and 73.6% were women; 55.1%, 53.2%, and 50.8% were Black; and 93.1%, 90.6%, and 91.1% were diagnosed with cystitis, respectively.


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The overall rate of guideline-concordant antibiotic prescriptions increased from 42.8% during phase zero to 49.7% and 56.1% during phases 1 and 2, respectively. The greatest increase in the rate of guideline-concordant antibiotic use was observed during phase 2 among patients admitted to the ED at a community hospital (64.1%).

Compared with phase zero, prescriptions for guideline-concordant antibiotics increased by 15% in phase 1 (incidence rate ratio [IRR], 1.15; 95% CI, 1.03-1.29; P =.02). In phase 2, prescriptions for guideline-concordant antibiotics increased by 3% for each 2-week interval (IRR, 1.03; 95% CI, 1.01-1.04; P <.01).

In regard to the overall rate of UTI diagnoses, no significant changes were observed throughout the duration of the study (P ³.37). Analyses of individual EDs showed significantly increased rates of UTI diagnoses at the 2 community hospitals compared with the academic hospital (both P <.01).

This study may have been limited by the use of diagnostic codes rather than patient symptoms to diagnosis UTI.

This study found that a multifaceted antibiotic stewardship program comprising education and performance feedback increased the use of guideline-concordant antibiotics among patients with UTIs admitted to an ED. “Future studies are warranted to examine other potential strategies to [decrease] inappropriate UTI diagnosis,” the researchers concluded.

Disclosure: Multiple authors declared affiliations with industry. Please see the original reference for a full list of disclosures.

Reference

Nys CL, Fischer K, Funaro J, et al. Impact of education and data feedback on antibiotic prescribing for urinary tract infections in the emergency department: An interrupted time series analysis. Clin Infect Dis. 2022;ciac073. doi:10.1093/cid/ciac073