1677 - Evaluation of Optimal Treatment for Urinary Tract Infections in Outpatient Clinics at an Academic Medical Center

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Presenting Author(s)

Jennifer Walters

PGY2 Internal Medicine Pharmacy Resident
VCU Health System
Arlington, Virginia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

JK

Jihye Kim

Clinical Pharmacist, Infectious Diseases/ASP
VCU Health System
Richmond, Virginia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MS

Michael Stevens

Associate Professor
Virginia Commonwealth University Health System
Richmond, Virginia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Inappropriate prescribing of antibiotics is an important modifiable risk factor for antibiotic resistance. The Joint Commission has identified the need for outpatient antimicrobial stewardship efforts. The purpose of this study was to assess the incidence of optimal empiric antibiotic therapy for urinary tract infections (UTIs) in outpatient clinics at VCU Health.

Methods: This was a retrospective study of patients seen in internal medicine (IM) and urology clinics between July 1, 2018 and June 30, 2019. Patients were included if they were ≥ 18 years old, had a diagnosis of UTI per ICD-10 code, and received a prescription to treat a UTI at the visit. Patients were excluded if they had a concurrent infection, currently prescribed antibiotics, or pregnant. The primary outcome was to evaluate the incidence of optimal empiric treatment for UTIs. Appropriateness of antibiotic therapy was assessed based on prior culture data along with our institutional UTI treatment guideline.

Results: Two hundred and twenty-six patients were included: 136 in IM clinics and 90 in urology clinics. Patients in the IM clinics were significantly older (mean age 64.8 vs. 60.5, p= 0.033) and more were female (88% vs. 38%, p< 0.001). More patients in the urology clinics had a history of a UTI within 24 months (72% vs. 57%, p= 0.016), history of fluoroquinolone-resistant Gram-Negative UTIs (35% vs. 13%, p= 0.007), and history of genitourinary cancer (28% vs. 1%, p< 0.001). Overall, 61% of patients were treated with optimal empiric antibiotics. Incidence of optimal prescribing in the IM clinics was significantly higher compared to urology clinics (69% vs 49%, p= 0.002). See table 1 for additional results.Table 1. Optimal UTI Treatment in Internal Medicine Clinics vs Urology Clinics

Conclusion: IM clinics more frequently prescribed optimal empiric antibiotics for UTIs compared to urology clinics. Resident prescribers were more likely to prescribe optimal empiric therapy. Presence of a beta-lactam allergy was not predictive of optimal prescribing. These data highlight opportunities for antibiotic therapy optimization for UTIs at our health system.