1337. An Outpatient Antimicrobial Stewardship Initiative for Urinary Tract Infections in Primary Care Pediatrics

Background Studies have showed that 30% of antibiotics prescribed in the outpatient setting are unnecessary. Acute UTI constitutes a significant health burden in outpatient pediatrics affecting ~2.8% of children every year. Antibiotics are often started empirically when diagnosing UTI making pediatric UTIs an ideal target for outpatient stewardship. The primary objective was to reduce the use of broad-spectrum empiric antibiotics with a secondary objective to study antibiotic discontinuation in culture negative cases. Methods The electronic medical records of two pediatric practices were screened for patients aged 2 months to 18 years diagnosed with uncomplicated UTI using ICD-10 codes N39, R30 and R35. The definition of a positive urine culture was > 50,000 CFU/ml if catheterized and > 100,000 CFU/ml if clean-catch specimen. A two-year pre-intervention period began in January 2018. An audit and review of urine culture processes were studied at each site with a subsequent educational intervention, a direct, one-hour session focused on the use of cephalexin as first-line empiric therapy based on the local antibiogram. The post-intervention period began at each site after the intervention. A COVID-19 sub-analysis was performed for the post-intervention period. Results During the study, 515 encounters and 113 encounters were included during the pre- and post-intervention periods, respectively. 74.4% (383/515) of pre-intervention encounters had empirically prescribed antibiotics; higher-generation cephalosporins (i.e. cefdinir, cefprozil) most frequently. Antibiotics were empirically prescribed in 75.2% (85/113) of post-intervention encounters with a statistically significant increase in cephalexin use (32/85, 37.6%, p < 0.01) and reduction in higher-generation cephalosporin use (p < 0.01), Figure 1. In the COVID-19 analysis, empiric antibiotic prescribing trended towards baseline as providers were relying largely on telemedicine, Figure 2. Figure 1: Empiric Antibiotic Prescribing Pre- and Post-InterventionF Figure 2: Empiric Antibiotic Prescribing - % Table 1: Pre- and Post-Intervention Conclusion The educational intervention was effective in changing antibiotic prescribing with an increased use of narrow spectrum antibiotics. This change waned without reinforcement and reliance on telemedicine during COVID-19. Antibiotic discontinuation in culture-negative cases remains an important area for improvement. Disclosures All Authors: No reported disclosures