Outpatient antimicrobial stewardship: Targets for urinary tract infections

Wattengel, Bethany A.; DiTursi, Sara; Schroeck, Jennifer; Sellick, John A.; Mergenhagen, Kari A.

doi:10.1016/j.ajic.2019.12.018

Cited by 9 publications

(10 citation statements)

References 24 publications

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“…A study comparing UTIassociated prescribing between 2002-2011 found that quinolones are used more frequently than SMX/TMP or nitrofurantoin for UTI, indicating widespread inappropriate use of antibiotics. 48 These suggestions are corroborated by Wattengel et al, who the US, 68% of outpatients were treated inappropriately for UTI with suboptimal regimens, dose, durations, and drug choice. 49 Stewardship efforts to combat the crisis of AMR within British Columbia were formalized provincially with the introduction of the Do Bugs Need Drugs campaign in late 2005.…”

Section: Cuaj -Original Researchmentioning

confidence: 88%

Outpatient prescribing and prophylactic antibiotic use for recurrent urinary tract infections in British Columbia, Canada

Saatchi

Yoo

Marra

2021

CUAJ

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Introduction: Urinary tract infections (UTI) are one of the most common infections, have frequent recurrences, and may debilitate quality of life. UTI is considered recurrent if there are three individual cases of UTI within 12 months. The objective of this study was to set a baseline for recurrent urinary tract infections (rUTI) in women, and rUTI-associated antibiotic prescribing in the presence of antimicrobial stewardship efforts. Methods: Data for rUTI in women were organized through a provincial prescription database, physician billing system, and a consolidation file to combine antibiotic prescribing, diagnoses and patient demographics. Rates of rUTI cases and prescriptions were examined, and trends of antibiotics were separated by major anatomical therapeutic chemical classes. Results: A total of 2 234 903 rUTI-associated prescriptions were dispensed for 674 785 rUTI cases from 2008–2018; 2 205 703 prescriptions were for treatment and 29 310 prescriptions were for prophylaxis of rUTI. The prevalence of rUTI cases declined by 59%, while overall rUTI-associated antibiotic prescribing decreased by 73%. The greatest decrease was seen in quinolones (87%), while nitrofurantoin became the most common rUTI-antibiotic dispensed, accounting for 42% of prescriptions overall. Conclusions: Implementation of numerous antimicrobial stewardship efforts may have contributed to the decrease in antibiotic prescribing, particularly for quinolones. In line with local antibiograms and guidelines, nitrofurantoin is the most used antibiotic for rUTI by far, distinctly preferred over other antibiotics secondary to the lack of E. coli resistance.

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Section: Cuaj -Original Researchmentioning

confidence: 88%

Outpatient prescribing and prophylactic antibiotic use for recurrent urinary tract infections in British Columbia, Canada

Saatchi

Yoo

Marra

2021

CUAJ

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“…According to Wattengel et al, [35] prescription of antibiotics for UTIs was suboptimal. Their retrospective analysis showed that 68% of patients treated for UTIs were treated inappropriately.…”

Section: Discussionmentioning

confidence: 99%

“…Incorrect duration (50.9%) was the most common error, followed by inappropriate choice of antibiotics (35.1%) and incorrect dosing (12.4%). [35] An SA study by Gasson et al [13] found that the duration of therapy was most often inappropriate (in 51.2% of urological infections), with inappropriate antibiotic selection in 17.1% of infections. The present study showed greater compliance in terms of overall antibiotic selection; however, antibiotic selection for treating complicated UTIs was mostly inappropriate, which was concerning in view of UTI complications and antibiotic resistance.…”

Section: Discussionmentioning

confidence: 99%

Treating urinary tract infections in public sector primary healthcare facilities in Cape Town, South Africa: A pharmaceutical perspective

2022

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Background. Antibiotic resistance is a global healthcare burden complicating the management of infections. Urinary tract infections (UTIs) are commonly treated in primary care. Managing UTIs appropriately in primary care can combat antibiotic resistance. The treatment practices for UTIs in primary care in Western Cape Province, South Africa, are not well described.Objectives. To describe treatment of UTIs in adults in primary care in the Cape Town metropole public sector of the Western Cape. Method. A retrospective multicentre medical records review of patients diagnosed with UTIs was conducted during 1 October 2020 - 28 February 2021. Six public sector primary healthcare facilities were included in the study through random selection from three of the four substructures in the Cape Town metropole. Medical records of adult patients diagnosed with UTIs, through clinical diagnosis or microbiological testing, were identified via a selective sampling process. Data were collected from medical records using a standardised data collection tool. Results. A total of 401 UTI episodes occurred in 383 patients during the study period. The majority of UTI episodes (84.3%) occurred in females, complicated UTIs (74.1%) were more common than uncomplicated UTIs, and nitrofurantoin (57.1%) was frequently prescribed, followed by ciprofloxacin (39.7%). Compliance with urine microscopy recommendations was low (6.7%), and antibiotics were appropriately selected in 75.0% of uncomplicated and 70.0% of complicated UTI episodes. Conclusion. Interventions are required to improve compliance with treatment recommendations as per the standard treatment guidelines, especially when selecting the appropriate antibiotic, duration of therapy and urine microscopy.

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“…Effective ambulatory ASPs in this survey often incorporated institutional guidelines for urinary tract infections and otitis, providing additional conditions to target. Previous literature has also suggested that pursuing ASP activities for these disease states may improve antimicrobial therapy [ 23 , 24 ]. More research is needed to guide effective ambulatory antimicrobial stewardship interventions.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Stewardship Practice in the Ambulatory Setting From a National Cohort

Eudy

Pallotta

Neuner

et al. 2020

Open Forum Infectious Diseases

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Background The majority of antimicrobial use occurs in the ambulatory setting. Antimicrobial stewardship programs (ASPs) are effective in improving appropriate prescribing and are now required by accreditation bodies. Methods This was a cross-sectional, multi-center survey describing the current state of ambulatory ASPs in a national cohort of Vizient member hospitals with ambulatory healthcare settings and serves as a benchmark for stewardship strategies related to program effectiveness. Results 129 survey responses from a variety of institution types across 44 states were received. Survey respondents reported a fully functioning ASP in 7% (9/129) of ambulatory practices compared to 88% (114/129) of inpatient institutions. Effectiveness in at least one antibiotic use related outcome (i.e. utilization, resistance, C. difficile infection, or cost) in the past two years was reported in 18% (18/100) of ambulatory and 84% (103/123) of inpatient ASPs. Characteristics of ambulatory ASPs demonstrating effectiveness were institution guidelines (89%, 16/18), rapid diagnostic testing (RDT) for respiratory viruses or group A Streptococcus (89% 16/18), outpatient antibiograms (78% 14/18), and dedicated pharmacist support (72%, 13/18). Ambulatory ASP effectiveness was shown to increase as programs met more of the Centers for Disease Control and Prevention (CDC) Core Elements of Outpatient Antimicrobial Stewardship (p<0.001). Conclusions ASPs are needed in the ambulatory setting, but are not common. Currently few ambulatory ASPs in this survey self-identify as fully functioning. The CDC Core Elements of antimicrobial stewardship should remain foundational for ASP development and expansion.

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Outpatient antimicrobial stewardship: Targets for urinary tract infections

Cited by 9 publications

References 24 publications

Outpatient prescribing and prophylactic antibiotic use for recurrent urinary tract infections in British Columbia, Canada

Outpatient prescribing and prophylactic antibiotic use for recurrent urinary tract infections in British Columbia, Canada

Treating urinary tract infections in public sector primary healthcare facilities in Cape Town, South Africa: A pharmaceutical perspective

Antimicrobial Stewardship Practice in the Ambulatory Setting From a National Cohort

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