We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Impact of Education and Data Feedback on Antibiotic Prescribing for Urinary Tract Infections in the Emergency Department: An Interrupted Time-Series Analysis.
- Authors
Nys, Cara L; Fischer, Kristen; Funaro, Jason; Shoff, Christopher J; Theophanous, Rebecca G; Staton, Catherine A; Mando-Vandrick, Jennifer; Toler, Rachel; Shroba, Jenny; Turner, Nicholas A; Liu, Beiyu; Lee, Hui Jie; Moehring, Rebekah W; Wrenn, Rebekah H
- Abstract
Background Urinary tract infections (UTIs) are often misdiagnosed or treated with exceedingly broad-spectrum antibiotics, leading to negative downstream effects. We aimed to implement antimicrobial stewardship (AS) strategies targeting UTI prescribing in the emergency department (ED). Methods We conducted a quasi-experimental prospective AS intervention outlining appropriate UTI diagnosis and management across 3 EDs, within an academic and 2 community hospitals, in North Carolina, United States. The study was divided into 3 phases: a baseline period and 2 intervention phases. Phase 1 included introduction of an ED-specific urine antibiogram and UTI guideline, education, and department-specific feedback on UTI diagnosis and antibiotic prescribing. Phase 2 included re-education and provider-specific feedback. Eligible patients included adults with an antibiotic prescription for UTI diagnosed in the ED from 13 November 2018 to 1 March 2021. Admitted patients were excluded. The primary outcome was guideline-concordant antibiotic use, assessed using an interrupted time-series regression analysis with 2-week intervals. Results Overall, 8742 distinct patients with 10 426 patient encounters were included. Ninety-two percent of all encounters (n = 9583) were diagnosed with cystitis and 8.1% with pyelonephritis (n = 843). There was an initial 15% increase in guideline-concordant antibiotic prescribing in phase 1 compared with the preintervention period (incidence rate ratio [IRR], 1.15; 95% confidence interval [CI], 1.03–1.29). A significant increase in guideline-concordant prescriptions was seen with every 2-week interval during phase 2 (IRR, 1.03; 95% CI, 1.01–1.04). Conclusions This multifaceted AS intervention involving a guideline, education, and provider-specific feedback increased guideline-concordant antibiotic choices for treat-and-release patients in the ED.
- Subjects
NORTH Carolina; ANTIBIOTICS; ANTIMICROBIAL stewardship; HOSPITAL emergency services; PYELONEPHRITIS; CONFIDENCE intervals; URINARY tract infections; RESEARCH methodology; INAPPROPRIATE prescribing (Medicine); RANDOMIZED controlled trials; PRE-tests &; post-tests; TREATMENT effectiveness; DRUG prescribing; TIME series analysis; DESCRIPTIVE statistics; PHYSICIAN practice patterns; STATISTICAL sampling; LONGITUDINAL method
- Publication
Clinical Infectious Diseases, 2022, Vol 75, Issue 7, p1194
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciac073