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. 2024 Oct 3;4(1):e158.
doi: 10.1017/ash.2024.437. eCollection 2024.

Effect of automated identification of antimicrobial stewardship opportunities for suspected urinary tract infections

Connor R Deri  1   2 , Rebekah W Moehring  2   3 , Nicholas A Turner  2   3 , Justin Spivey  4 , Sonali D Advani  2   3 , Rebekah H Wrenn  1   2 , Michael E Yarrington  2   3
Affiliations

Effect of automated identification of antimicrobial stewardship opportunities for suspected urinary tract infections

Connor R Deri et al. Antimicrob Steward Healthc Epidemiol. .

Abstract

Objective: We aimed to determine whether automated identification of antibiotic targeting suspected urinary tract infection (UTI) shortened the time to antimicrobial stewardship (AS) intervention.

Design: Retrospective before-and-after study.

Setting: Tertiary and quaternary care academic medical center.

Patients: Emergency department (ED) or admitted adult patients meeting best practice alert (BPA) criteria during pre- and post-BPA periods.

Methods: We developed a BPA to alert AS pharmacists of potential ASB triggered by the following criteria: ED or admitted status, antibiotic order with genitourinary indication, and a preceding urinalysis with ≤ 10 WBC/hpf. We evaluated the median time from antibiotic order to AS intervention and overall percent of UTI-related interventions among patients in pre-BPA (01/2020-12/2020) and post-BPA (04/15/2021-04/30/2022) periods.

Results: 774 antibiotic orders met inclusion criteria: 355 in the pre- and 419 in the post-BPA group. 43 (35 UTI-related) pre-BPA and 117 (94 UTI-related) post-BPA interventions were documented. The median time to intervention was 28 hours (IQR 18-65) in the pre-BPA group compared to 16 hours (IQR 2-34) in the post-BPA group (P < 0.01). Despite absent pyuria, there were six cases with gram-negative bacteremia presumably from a urinary source.

Conclusions: Automated identification of antibiotics targeting UTI without pyuria on urinalysis reduced the time to stewardship intervention and increased the rate of UTI-specific interventions. Clinical decision support aided in the efficiency of AS review and syndrome-targeted impact, but cases still required AS clinical review.

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Conflict of interest statement

S.D.A. reports support from the Centers from Disease Control and Prevention (grant nos. 5U54CK000616-02 and SHEPheRD 75D30121D12733-D5-E003), National Institutes of Health (National Institute of Diabetes and Digestive and Kidney Diseases grant no. K12DK100024), the Society for Healthcare Epidemiology of America, and as well as prior consulting fees from Locus Biosciences, Sysmex America, GlaxoSmithKline, bioMérieux, and the Infectious Diseases Society of America. Additionally, S.D.A is an employee of GSK/ViiV Health care as of July 1, 2024 and holds stock in GlaxoSmithKline.

Figures

Figure 1.
Figure 1.
Time-to-event cumulative incidence plot.
Figure 2.
Figure 2.
Time to AS intervention and UTI-related interventions.
Figure 3.
Figure 3.
Length of therapy in intervened patients among pre- and post-BPA groups.
See this image and copyright information in PMC

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