131 - Antimicrobial Usage for Respiratory Infections in Urgent Care Settings within the University of Washington Medicine Network

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Presenting Author(s)

Joanne Huang

Clinical Pharmacist - Infectious Diseases
Massachusetts General Hospital , Massachusetts
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Zahra Kassamali Escobar

Clinical Pharmacist, Infectious Diseases
UW Medicine Valley Medical Center
Renton, Washington
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Rupali Jain

Clinical Associate Professor
University of Washington Medical Center-Montlake
Seattle, WA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JC

Jeannie D. Chan

Antimcirobial Stewardship Pharmacist
University of Washington
Seattle, Washington
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
John B. Lynch

Professor
Harborview Medical Center/University of Washington
Seattle, WA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Marisa A. D'Angeli

Medical Epidemiologist
Washington State Department of Health
Shoreline, WA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
VF

Victoria Fang

Associate Medical Director
UW Neighborhood Clinics
Seattle, Washington
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Larissa May

Director Emergency Department Antibiotic Stewardship
University of California Davis
Sacramento, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Chloe Bryson-Cahn

Medical Director, Antimicrobial Stewardship Harborview Medical Center
Harborview Medical Center
Seattle, Washington
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: In an effort to combat antimicrobial resistance and adverse drug events, The Joint Commission mandated expansion of antimicrobial stewardship programs into ambulatory healthcare settings Jan 2020. The most common diagnoses resulting in inappropriate antimicrobial prescribing are respiratory infections. This study aimed to assess the rate of antibiotic prescribing for viral respiratory tract infections within six urgent care clinics affiliated with University of Washington Medicine health system in Seattle, WA.

Methods: This was a retrospective observational study from Jan 2019-Feb 2020. We used the MITIGATE toolkit; a resource that meets CDC’s core elements for outpatient stewardship. Patients were identified based upon pre-specified ICD-10 codes for viral respiratory infections. The primary outcome was the rate of unnecessary antimicrobial prescriptions for acute viral respiratory infections. Secondary outcomes evaluated inappropriate prescribing practices based on antibiotic selection, diagnosis, and age.

Results: Of 7,313 patients (6078 adults and 1235 pediatric) included, 23% were inappropriately prescribed antibiotics. The most common antibiotics inappropriately prescribed were azithromycin (62%), amoxicillin (13%), and doxycycline (13%). Fluoroquinolone (FQ) utilization was low (2%). Bronchitis (61%) and nonsuppurative otitis media (NSOM) (24%) were the most common viral diagnoses for which antibiotics were prescribed. Overall, unnecessary prescribing was lower in pediatrics than adults at 13% and 25%, respectively (p< 0.001). Adults were more often prescribed antibiotics inappropriately for bronchitis and NSOM compared to pediatrics (p=0.0013).

Conclusion: Inappropriate prescribing practices across six urgent care clinics varied based upon age and diagnosis. Azithromycin is most often inappropriately prescribed but the low rate of FQ prescribing is encouraging. The lower rate of unnecessary prescribing in pediatrics is promising although there is room for improvement as 1 in 8 children were unnecessarily prescribed antibiotics. These findings support the need for antibiotic stewardship in the outpatient setting, targeting areas for azithromycin use and therapeutic management of bronchitis.