The Five Ds of Outpatient Antibiotic Stewardship for Urinary Tract Infections (original) (raw)
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How Does Antimicrobial Stewardship Affect Inappropriate Antibiotic Therapy in Urological Patients?
Antibiotics, 2020
Antimicrobial stewardship teams (ASTs) have been well-accepted in recent years; however, their clinical outcomes have not been fully investigated in urological patients. The purpose of this study was to evaluate the outcomes of intervention via a retrospective review of urological patients, as discussed in the AST meetings, who were treated with broad-spectrum antibiotics between 2014 and 2018 at the Department of Urology, Kobe University Hospital in Japan. Interventions were discussed in AST meetings for patients identified by pharmacists as having received inappropriate antibiotic therapy. The annual changes in numbers of inappropriate medications and culture submissions over five years at the urology department were statistically analyzed. Among 1,033 patients audited by pharmacists, inappropriate antibiotic therapy was found in 118 cases (11.4%). The numbers of inappropriate antibiotic use cases and of interventions for indefinite infections had significantly decreased during th...
Urinary Tract Infections: Leading Initiatives in Selecting Empiric Outpatient Treatment (UTILISE)
The Canadian Journal of Hospital Pharmacy, 2014
Overuse of fluoroquinolone antibiotics is associated with outbreaks of methicillin-resistant Staphylococcus aureus and of Clostridium difficile-associated diarrhea and increasing resistance in gram-negative organisms. Over the past decade, resistance of Escherichia coli to ciprofloxacin has increased in the Regina Qu'Appelle Health Region. In August 2011, an exploratory audit of the Regina General Hospital (RGH) emergency department showed that 20% of new antibiotic orders were for fluoroquinolones, and 60% of these new fluoroquinolone orders were for ciprofloxacin. It was postulated that ciprofloxacin was predominantly prescribed for outpatients with urinary tract infection.
A call to action for outpatient antibiotic stewardship
Journal of the American Pharmacists Association : JAPhA, 2017
To address the public health threat of antibiotic resistance, there has been an enhanced call for antibiotic stewardship programs throughout the health care continuum. While antibiotic stewardship programs have been well described in the inpatient setting, data on effectiveness and guidance on implementing outpatient programs is scarce. Establishing stewardship practices in the outpatient setting is necessary because more than 60% of human antibiotic use occurs in this setting. In this article, we highlight the importance and need for stewardship in the outpatient setting, discuss strategies for the development of stewardship teams, and discuss potential metrics that can be used to assess effectiveness of antibiotic stewardship interventions.
Antibiotics and Urinary Tract Infections
MDPI eBooks, 2015
Urinary tract infections are the most common bacterial infections encountered in ambulatory and long-term care settings in the United States. Urine samples are the largest single category of specimens received by most microbiology laboratories and many such cultures are collected from patients who have no or questionable urinary symptoms. Unfortunately, antimicrobials are often prescribed inappropriately in such patients. Antimicrobial use, whether appropriate or inappropriate, is associated with the selection for antimicrobial-resistant organisms colonizing or infecting the urinary tract. Infections caused by antimicrobial-resistant organisms are associated with higher rates of treatment failures, prolonged hospitalizations, increased costs and mortality. Antimicrobial stewardship consists of avoidance of antimicrobials when appropriate and, when antimicrobials are indicated, use of strategies to optimize the selection, dosing, route of administration, duration and timing of antimicrobial therapy to maximize clinical cure while limiting the unintended consequences of antimicrobial use, including toxicity and selection of resistant microorganisms. This article reviews successful antimicrobial stewardship strategies in the diagnosis and treatment of urinary tract infections.
Outpatient antibiotic stewardship: Interventions and opportunities
Journal of the American Pharmacists Association : JAPhA, 2017
Improving the use of antibiotics across the continuum of care is a national priority. Data outlining the misuse of antibiotics in the outpatient setting justify the expansion of antibiotic stewardship programs (ASPs) into this health care setting; however, best practices for outpatient antibiotic stewardship (AS) are not yet defined. In a companion article, we focused on recommendations to overcome challenges related to the implementation of an outpatient ASP (e.g., building the AS team and defining program metrics). In this document, we outline AS interventions that have demonstrated success and highlight opportunities to enhance AS in the outpatient arena. This article summarizes examples of point-of-care testing, policies and interventions, and education strategies to improve antibiotic use that can be used in the outpatient setting.
Antibiotic Appropriateness for Urinary Tract Infection in the Emergency Room
Bahrain Medical Bulletin
Background: Urinary Tract Infections (UTI) are a common cause of emergency room (ER) visits and antibiotic misuse. Objective: To evaluate the characteristics of UTI attending ER and to assess antibiotic prescription and inappropriate treatment implications. Design: A Prospective Study. Setting: Salmaniya Medical Complex, Bahrain. Method: Patients aged more than 14 years who presented to the ER with UTI from 1 July 2014 to 31 July 2014 were reviewed. Data was obtained from patients' emergency records and classified according to the type of UTI as complicated, uncomplicated or UTI in pregnancy. Antibiotic treatment was considered appropriate if it followed the Local or International Guidelines. Result: A total of 239 patients were included in the study; 83 (34.7%) were males, 75 (31.4%) were pregnant females and 81 (33.9%) were non-pregnant females, the mean age was 37.56 years. One hundred forty-five (60.7%) patients had complicated UTI. The most prescribed antibiotics were cefuroxime and ciprofloxacin. Seventy-two (30.1%) of inappropriate antibiotics prescription were mostly due to improper duration. Inappropriate antibiotic treatment was significantly more common among males, 43 (17.9%) P-value <0.001; complicated UTI were 63 (26.4%), P-value <0.001. One hundred thirty-three (55.6%) prescriptions were written by emergency doctors, P-value <0.001. There was no significance among the different age groups. Conclusion: High rate of inappropriate antibiotics use in UTI patients mostly in complicated UTI and in patients treated by emergency doctors physicians.
Infection, 2016
In 2012-2013, a cross-sectional survey was conducted in women visiting a general practitioner for urinary tract infection (UTI), to estimate the annual incidence of UTIs due to antibiotic-resistant Escherichia coli (E. coli). A sampling design (stratification, stages and sampling weights) was taken into account in all analyses. Urine analyses were performed for each woman and centralised in one laboratory. Among 538 included women, urine culture confirmed UTI in 75.2 % of cases. E. coli represented 82.8 % of species. Among E. coli, resistance (I + R) was most common to amoxicillin [38 % (95 % confidence interval 31.1-44.5)] and to trimethoprim/sulfamethoxazole [18.1 % (12.0-24.1)]. Resistance to ciprofloxacin and cefotaxime was lower [1.9 % in both cases, (0.3-3.5)], as it was for nitrofurantoin [0.4 (0-1.0)] and fosfomycin (0). Extended-spectrum β-lactamase (ESBL) represented 1.6 % of E. coli (0.2-2.9). Annual incidence rate of confirmed UTI was estimated at 2400 per 100,000 women ...