Urinary Tract Infections: Leading Initiatives in Selecting Empiric Outpatient Treatment (UTILISE)

Landry, E. S.; Sulz, Linda; Bell, Ali; Rathgeber, Lane; Balogh, Heather

doi:10.4212/cjhp.v67i2.1339

Cited by 10 publications

(19 citation statements)

References 15 publications

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“…Previous studies describing ASP interventions in the ED have been limited in scope to uncomplicated UTIs and consequently focused on a lower-risk patient population than that seen in our study [ 18 , 21 , 22 , 34 , 35 ]. In contrast, we sought to address the needs of our diverse ED population comprised of patients with varying levels of comorbidity and index infection severity.…”

Section: Discussionmentioning

confidence: 99%

Leveraging Antimicrobial Stewardship in the Emergency Department to Improve the Quality of Urinary Tract Infection Management and Outcomes

Jorgensen

Yeung

Zurayk

et al. 2018

Open Forum Infectious Diseases

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BackgroundThe complex and fast-paced emergency department (ED) practice setting presents unique challenges that demand a tailored approach to antimicrobial stewardship. In this article, we describe the strategies applied by 1 institution’s antimicrobial stewardship program (ASP) that were successful in improving prescribing practices and outcomes for urinary tract infection (UTI) in the ED.MethodsCore strategies included pre-implementation research characterizing the patient population, antimicrobial resistance patterns, prescribing behavior, and morbidity related to infection; collaboration across multiple disciplines; development and implementation of a UTI treatment algorithm; education to increase awareness of the algorithm and the background and rationale supporting it; audit and feedback; and early evaluation of post-implementation outcomes.ResultsWe observed a rapid change in prescribing post-implementation with increased empiric nitrofurantoin use and reduced cephalosporin use (P < .05). Our elevation of nitrofurantoin to firstline status was supported by our post-implementation analysis showing that its use was independently associated with reduced 30-day return visits (adjusted odds ratio, 0.547; 95% confidence interval, 0.312–0.960). Furthermore, despite a shift to a higher risk population and a corresponding decrease in antimicrobial susceptibility rates post-implementation, the preferential use of nitrofurantoin did not result in higher bug-drug mismatches while 30-day return visits to the ED remained stable.ConclusionsWe demonstrate that an outcomes-based ASP can impart meaningful change to knowledge and attitudes affecting prescribing practices in the ED. The success of our program may be used by other institutions as support for ASP expansion to the ED.

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Section: Discussionmentioning

confidence: 99%

Leveraging Antimicrobial Stewardship in the Emergency Department to Improve the Quality of Urinary Tract Infection Management and Outcomes

Jorgensen

Yeung

Zurayk

et al. 2018

Open Forum Infectious Diseases

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“…Tendo em vista que tais taxas vem aumen- [16][17][18][19] tando em outros locais do Brasil e do mundo, ve-se a necessidade de tal estudo em âmbito local para nortear um tratamento clıń ico mais adequado. Já foram realizados, em escala multicentrica, estudos semelhantes.…”

Section: Discussionunclassified

“…A bacteŕia mais encontrada foi E. coli (78,37%), o 1,2,5,6,9,11,[16][17][18][19][20][21] que corrobora com outros estudos. Em seguida, tem-se Klebsiella sp, Enterococcus faecalis e Staphylococ- 7,9,11 cus aureus, resultado esse variante quanto à literatura.…”

Section: Discussionunclassified

Análise da resistência às quinolonas e sulfametoxazol-trimetoprim em uroculturas positivas para Escherichia coli em infecções do trato urinário comunitárias no período de 2010 a 2014 em Itajubá – MG / Analysis of quinolones and trimethoprim-sulfamethoxazole resistance in positive Escherichia coli urucultures in urinary tract infections in a community environment from 2010 to 2014 in Itajubá – MG

Silva¹,

Costa²,

Grilo³

et al. 2017

Rev Cienc Saude

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Introdução: As infecções do trato urinário (ITU), de origem comunitária, são diagnósticos muito prevalentes a nível ambulatorial, sendo uma grande causa de uso de antibioticoterapia. Seus agentes etiológicos mais prevalentes são os bacilos gram-negativos da família Enterobacteriaceae, em especial a Escherichia coli (E. coli). Visando este agente, as terapias antimicrobianas empíricas mais utilizadas no Brasil são o sulfametoxazol-trimetoprim, quinolonas, cefalosporinas de 1º e 2º geração, amoxicilina e nitrofurantoína. Objetivos: Tendo em vista o aumento da antibioticorresistência a estes medicamentos, demonstrado na literatura médica mundial, e a importância do conhecimento deste dado pela comunidade médica local, este artigo pretende traçar o perfil de resistência às quinolonas e ao sulfametoxazol-trimetoprim pelas cepas de E. coli isoladas de uroculturas de ITU comunitária, encaminhadas para um laboratório de análises clínicas, de uma cidade do sul de Minas Gerais, no período de 2010 a 2014. Métodos: Estudo descritivo e retrospectivo por meio de pesquisa em banco de dados, no período de 2010 a 2014. Foram realizadas análises de urocultura e antibiograma, com cálculo estatístico utilizando-se o teste qui-quadrado. Resultados: Foram obtidas 14870 uroculturas, tendo crescimento bacteriano maior que 105 unidades formadoras de colônia (UFC) em 3073 amostras, das quais 2203 foram cepas de E. coli e 870 de outras bactérias. A taxa global de resistência nos 5 anos de todos os antibióticos foi de 24,46%, sendo que a de sulfametoxazol-trimetoprim em específico foi de 19,65% e a do grupo quinolonas, 19,2%. Observou-se aumento da resistência ao longo dos 5 anos (p<0,0001) e que é mais incidente em mulheres e em maiores de 65 anos. Conclusão: As taxas de resistência às quinolonas e ao sulfametoxazol-trimetoprim atingiram níveis próximos do limiar permitido para seu uso empírico. A idade e o gênero mostram-se fatores importantes na antibioticorresistência, especialmente nos maiores de 65 anos e no gênero feminino.Palavras-chave: Infecções urinárias; Farmacorresistência bacteriana; Infecções comunitárias adquiridas; Quinolonas; Trimetropima-sulfametoxazolABSTRACTIntroduction: Communitarian urinary tract infections are frequently diagnosed ambulatorily, and they are the most important cause for using antibiotic therapy. Its most common agents are gram-negative bacils from the enterobacteriaceae family, especially Escherichia coli (E. coli). Focusing on this bacterium, the empiric antibiotic therapies which are mostly used in Brazil are trimethoprim/sulfamethoxazole, quinolones, 1st and 2nd generation of cephalosporin, amoxicillin, and nitrofurantoin. Aims: Foreseeing the intense growth of antibiotic therapy resistance to these drugs shown in the world's medical literature and the importance of local medical community having knowledge of this data, this article proposes the research of quinolones and trimethoprim-sulfamethoxazole combination resistance to E. coli bacteria isolated in community-acquired UTI urocultures, from a clinical analysis laboratory, in the period from 2010 to 2014 in a southern city of the state of Minas Gerais. Methods: Retrospective and descriptive study by database research in the period from 2010 to 2014. Urocultures and antibiogram analysis were done, and the statistic calculous were made by using qui-square's test. Results: 14870 urocultures were studied. However, only 3073 samples had significant bacterial growth (bigger than 105CFU). From this result, 2203 were E. coli samples and 870 were from other bacteria. The global resistance in this 5 year study for all antibiotics was 24,46 %. Furthermore, trimethoprim-sulfamethoxazole combination resistance was 19,65% and the quinolones group was 19,2%. Through research, we have noticed an increasing resistance through these five years (p<0,0001), thus, having bigger incidence in woman and in people older than 65 years old. Conclusion: Antibiotic resistance rates almost reach unacceptable levels for therapeutic use. Age and gender demonstrated importance at antibiotic resistance, especially for people older than 65 years of age and the feminine gender.Keywords: Urinary tract infections; Drug resistance bacterial; Community-acquired infections; Quinolones; Trimethoprim-sulfamethoxazole

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“…The intervention resulted in an increase in guideline adherent recommendations (44.8% versus 83%, p < 0.001), increased nitrofurantoin use (12% versus 80%, p < 0.001), and increased effective empiric treatment regimens (74% versus 89%, p = 0.05). Similarly, Landry et al developed a treatment algorithm for uncomplicated UTIs coupled with physician education, which involved direct education to the ED providers and nursing managers [19]. Posters of the algorithm were also displayed in the ED and posted on the intranet.…”

Section: Urinary Tract Infectionsmentioning

confidence: 99%

BundlED Up: A Narrative Review of Antimicrobial Stewardship Initiatives and Bundles in the Emergency Department

et al. 2019

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Antimicrobial stewardship (ASP) is becoming an increasingly high priority worldwide, yet the emergency department (ED) is an area where stewardship is often neglected. Implementing care bundles, guidelines, and protocols appears to be a rational strategy for ED stewardship given the inherently dynamic and hectic environment of care. Multiple questions still exist such as whether to target certain disease states, optimal implementation of ASP interventions in the ED, and the benefit of unique ED-specific guidelines and protocols. A narrative review was performed on interventions, guidelines, and bundles implemented in the ED setting, in an effort to improve ASP or management of infectious diseases. This review is meant to serve as a framework for the reader to implement these practices at their own institution. We examined various studies related to ASP interventions or care bundles in the ED which included: CNS infections (one study), skin and soft-tissue infections (one study), respiratory infections (four studies), urinary tract infections and sexually transmitted infections (eight studies), sepsis (two studies), culture follow-up programs (four studies), and stewardship in general or multiple infection types (five studies). The interventions in this review were diverse, yet the majority showed a benefit in clinical outcomes or a decrease in antimicrobial use. Care bundles, guidelines, and antimicrobial stewardship interventions can streamline care and improve the management of common infectious diseases seen in the ED.

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Urinary Tract Infections: Leading Initiatives in Selecting Empiric Outpatient Treatment (UTILISE)

Cited by 10 publications

References 15 publications

Leveraging Antimicrobial Stewardship in the Emergency Department to Improve the Quality of Urinary Tract Infection Management and Outcomes

Leveraging Antimicrobial Stewardship in the Emergency Department to Improve the Quality of Urinary Tract Infection Management and Outcomes

BundlED Up: A Narrative Review of Antimicrobial Stewardship Initiatives and Bundles in the Emergency Department

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