60 - Discontinuation of Empiric Antibiotic Therapy for Urinary Tract Infection Utilizing Non-Physician Providers in the Emergency Department

Poster Number: 60
Publication Number: 60.408

Benjamin McMillion, University of Louisville School of Medicine, Louisville, KY, United States; Danielle Graff, University of Louisville School of Medicine, Louisville, KY, United States; Navjyot K. Vidwan, University of Louisville School of Medicine, Louisville, KY, United States

Background:
Treating urinary tract infections (UTIs) when culture data does not support this diagnosis leads to unnecessary antibiotic exposure. In the ED setting, patients are prescribed empiric antibiotics if UTI is suggested by urinalysis and sent home without follow up to final culture results. With the continued rise of antibiotic resistance, especially enteric pathogens, the need to limit inappropriate antibiotic exposure is paramount.

Objective: Develop a multidisciplinary pathway driven process to increase the rate of discontinuation of empiric antibiotics in patients who were discharged from the ED in which urine culture does not support the diagnosis of UTI.

Design/Methods: Urine cultures from ED patients with a discharge diagnosis of UTI (age 3m-21y) were reviewed daily by either an ED pharmacist or Nurse Practitioner. Based on culture results and review of medical records, providers followed one of three specific pathways developed with the assistance of Infectious Disease, Emergency Medicine, and pharmacy. Chart runs were performed monthly after completion of 3-month baseline data. Various interventions and tools were developed to improve discontinuation and are being implemented in PDSA cycles, utilizing precent of appropriately discontinued antibiotics as a marker of success with return within 30-day period for similar symptoms as balancing measures. Days saved of therapy and average time spent per day on intervention were also tracked. Exclusion criteria were pre-existing renal/urologic abnormality, immunocompromise, antibiotic use within previous seven days, and/or discharged home with antibiotics for another bacterial infection.

Results: In a preliminary analysis, 500 records were reviewed. 100 patients qualified for inclusion. The pre-intervention average was 0% discontinuation while the post-intervention average increased to 30% (SD=15) over a 7-month period. The mean number of antibiotic days saved was 6.5 days/patient. No patients returned within a 30-day period for complications related to discontinued antibiotics. The new process took 45 minutes per day for individuals to chart review, call families, and document.Conclusion(s):
Our intervention continues to build on the evidence that discontinuation of empiric antibiotics for UTI when cultures result negative is an effective and safe process. By utilizing non-physician PEM care team members, we had significant improvement in percentage of antibiotics discontinued, while maintaining patient safety, and without increasing hospital/departmental cost.