The role of a stewardship pharmacist in the treatment of urinary tract infections on an outpatient basis

Urinary tract infections (UTI) continue to be one of the most common bacterial infections. Studies have shown that adding an outpatient pharmacist responsible for antimicrobial stewardship (ASP) can have a positive impact on UTI antibiotic prescribing practices.

Novant Health in North Carolina has started a pilot program with a UTI care pathway to guide empiric treatment and using an infectious disease pharmacist to provide education, feedback and support at select outpatient clinics.

A team of investigators conducted a retrospective study at 2 Novant outpatient clinics to determine if this actually contributed to the results. “The composite endpoint being the appropriate selection of antibiotics, dose and duration of UTI treatment. Secondary endpoints included an analysis of each component of the primary endpoint, the impact of informational questions on provider-initiated medications, the incidence of empirical antibiotic incompatibility between the organism, and the incidence of mismatches that have not been prescribed for appropriate definitive treatment,” the investigators wrote. Subgroup analysis of appropriate management at each clinical site was performed.”

There were a total of 211 patients with 126 of them in the pre-ASP group and 85 in the post-ASP group. The majority of patients were prescribed nitrofurantoin.

The investigators noted that “Appropriate UTI management occurred in 66 (61%) of the pre-ASP group compared to 46 (62%) of the post-ASP group (p=0.83) . No significant differences were observed in appropriate selection, dose, or duration between groups (p=0.34; p=0.39; p=0.75). There were 11 questions asked by the provider and 36 empirical antibiotic discrepancies between organizations (17 in pre-ASP, 19 in post-ASP) with only 1 discrepancy not prescribed for appropriate definitive treatment. »

They also found that there was no difference in the appropriate management of UTIs in the Clinic A cohort (pre-ASP 83%; post-ASP 83%; p=1). However, the investigators found a significant increase in the appropriate management of UTIs in the clinic’s cohort B (pre-ASP 16%; post-ASP 42%; p=0.01).

“Improvement in appropriate management of UTIs was observed after implementation of a UTI care pathway and an infectious disease pharmacist pilot in outpatient clinics,” wrote investigators.

The study, “Ambulatory Antimicrobial Stewardship Impact on Treatment of Urinary Tract Infections,” was presented at the 24th Annual Meeting Making a Difference in Infectious Disease (MAD-ID) 2022 in Orlando, Florida, May 18-21.

Contagion spoke with study co-author Melanie Schrack, PharmD, at the MAD-ID meeting, who provided information about the study and how ASPs can help guide treatment.

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