title: Impact of an antimicrobial stewardship intervention on urinary tract infection treatment in the ED.
abstract: OBJECTIVE
  The study objective is to assess changes in treatment of uncomplicated urinary tract infections (UTIs) after implementation of recommendations based on national guidelines and local resistance rates.
  
  
  METHODS
  This preintervention and postintervention study included patients discharged home from the emergency department (ED) with an uncomplicated UTI at a 439-bed teaching hospital. Emergency department prescribers were educated on how local antimicrobial resistance rates impact UTI practice guidelines. Empiric treatment according to recommendations was assessed as the primary outcome. Agreement between chosen therapy and isolated pathogen susceptibility was compared before and after education. Reevaluation in the ED or hospital admission within 30 days for a UTI was also evaluated.
  
  
  RESULTS
  A total of 350 patients were studied (174 before and 176 after education). Of those, 255 had cystitis, and 95 had pyelonephritis. After education, choice of therapy consistent with recommendations increased from 44.8% to 83% (difference, 38.2%; 95% confidence interval [CI], 33%-43%; P < .001). The change was predominately driven by an increase in nitrofurantoin use for cystitis from 12% to 80% (difference, 68%; 95% CI, 62%-73%; P < .001). Agreement between empiric treatment and the isolated pathogen susceptibility improved for cystitis 74% to 89% (P = .05), and no change occurred in 30-day repeat ED visits for a UTI.
  
  
  CONCLUSIONS
  After implementation of treatment recommendations for uncomplicated UTIs based on local resistance, empiric antibiotic selection improved in the ED. To further meet goals of antimicrobial stewardship, additional interventions are needed.
authors.affiliation: Department of Pharmacy, HSHS St John's Hospital, 800 East Carpenter Ave, Springfield, IL, USA 62769. Electronic address: Kelly.percival@drake.edu.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Percival
authors.affiliation: Department of Pharmacy, HSHS St John's Hospital, 800 East Carpenter Ave, Springfield, IL, USA 62769. Electronic address: Kristine.valenti@hshs.org.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Valenti
authors.affiliation: Department of Pharmacy, HSHS St John's Hospital, 800 East Carpenter Ave, Springfield, IL, USA 62769. Electronic address: stacy.schmittling@hshs.org.
authors.forename: Stacy E
authors.initials: SE
authors.lastname: Schmittling
authors.affiliation: Department of Pharmacy, HSHS St John's Hospital, 800 East Carpenter Ave, Springfield, IL, USA 62769. Electronic address: Brandi.Strader@hshs.org.
authors.forename: Brandi D
authors.initials: BD
authors.lastname: Strader
authors.affiliation: Division of Emergency Medicine, Southern Illinois University School of Medicine, PO Box 19639 Springfield, IL, USA 62794. Electronic address: rlopez@siumed.edu.
authors.forename: Rebecka R
authors.initials: RR
authors.lastname: Lopez
authors.affiliation: Department of Pharmacy Practice, Southern Illinois University Edwardsville School of Pharmacy, 701 N 1st St, Box 19636 Springfield, IL, USA 62794. Electronic address: scbergm@siue.edu.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Bergman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D002648:Child; D003556:Cystitis / Q000188:drug therapy*; D024881:Drug Resistance, Bacterial; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011704:Pyelonephritis / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents