Outpatient antimicrobial stewardship: Targets for urinary tract infections

Background: Urinary tract infections (UTIs) are common. Outpatient antimicrobial stewardship programs are emerging and a focused approach to UTIs is needed to help guide programs. Methods: Data were collected by retrospective chart review of outpatients using encounters from January 2005 to March 2018. Antibiotic therapy was indicated if at least one UTI symptom was present. Antibiotic therapy was appropriate if consistent with guidelines and culture results. Factors that differed significantly (P <.05) between the comparator groups were built into a multivariable logistic regression model to determine factors associated with inappropriate prescribing. Results: A total of 607 outpatients were included, of which approximately 68% were treated inappropriately. Inappropriate regimens consisted of 50.9% (n = 309) incorrect durations, 35.1% (n = 213) incorrect choice of antibiotic, and 12.4% (n = 75) incorrect doses. Ten percent of patients developed a reinfection within 30 days. Recurrence of UTI with the same pathogen within 30 days occurred in 5.1%. Catheter use and advanced age are both risk factors for recurrence and inappropriate treatment. Conclusions: Outpatient antibiotic prescribing for UTIs is suboptimal. Stewardship programs should focus on patients with catheters and of advanced age as they are often inappropriately treated. Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.