O3026: Increasing Use of Narrow-spectrum Antibiotics in an Urgent Care Organization

Purpose/Objectives: Treatment of urinary tract infection (UTI) accounts for substantial antibiotic exposure in children. In our pediatric urgent care centers, which has offices across the nation, the use of broad-spectrum antibiotics and for long duration was common for treatment of UTI. The objective of this quality improvement (QI) study was to address practice variation, review evidence-based treatment for UTI and increase the use of narrow spectrum antibiotics.

Design/Methods: Using QI methodology, we set our aim to increase the percent use of narrow spectrum antibiotics (amoxicillin, cephalexin, nitrofurantoin, trimethoprim-sulfamethoxozole) for patients treated for UTI, from a baseline of 40 percent (August 2019-December 2020) to a goal of 80 percent by August 30, 2021 and sustain that goal for 6 months for the population of children > 2 years of age. The guideline for the treatment for UTI was updated January 2021, prior to project initiation. A companywide educational webinar was done in March 2021. The project was started in one region of the organization in April 2021, and then introduced to the rest of the company in June/July 2021 (Figure 1). Strategies to encourage provider buy-in included reviewing local antibiograms, reviewing current evidence-based literature, and the antibiotic practices of large academic institutions. MOC part 4 credit was given to providers who demonstrated meaningful participation in the project. Regional leaders oversaw several states and met monthly to review data, discuss setbacks and encourage participation and compliance.

Results: From January 2021 onwards, we saw a steady increase in the percent use of narrow spectrum antibiotics and finally reaching the goal of 80 percent by July 2021, the month of the official roll out to the entire organization. This was likely explained by the introduction of the revised UTI guideline in the beginning of 2021, and the educational webinar presented in March 2021 both of which created an awareness of the initiative before the official roll out. The goal of 80 percent has been sustained till date for the entire organization (Figure 2).

Conclusion/Discussion: Our QI project to improve antimicrobial stewardship was unique because it was successfully implemented in an organization with offices throughout the country in different regions with their own subculture, local practice habits and varying patient population. We also concurrently saw an increase of use of narrow spectrum antibiotics in our younger population of > 3 months to 2 years to nearly 80 percent and sustained till date even though this was not the study population. The success of this project on such a large scale is a testimony to the QI methodology which was used in this case to empower physicians and mid level providers to practice evidence based antimicrobial stewardship.