127. A Retrospective Review of Antibiotic Appropriateness for Urinary Tract Infections in Ambulatory Patients

Background The Centers for Disease Control and Prevention and the Joint Commission recommend establishing antibiotic stewardship in outpatient settings. Previous studies estimate over half of all antibiotic prescriptions in the outpatient setting for any indication are inappropriate. Urinary tract infections present a key stewardship opportunity, as most fluoroquinolones prescribed for acute uncomplicated cystitis are potentially inappropriate and many safety concerns exist for this drug class. This study evaluates the outpatient antimicrobial prescribing practices for cystitis and other urinary tract infections at ambulatory clinics within a health system. Methods This retrospective cohort study includes adults treated for cystitis or urinary tract infection at 60 primary care and 21 specialty clinics within a large academic health system over a three-year period. Diagnosis codes and individual chart review were used to collect data. The primary outcome is the proportion of patients prescribed antibiotics for urinary tract infection who received a fluoroquinolone. Results Of 22,099 encounters which included one of the diagnosis codes indicative of cystitis, an antibiotic was prescribed in 19,101 (86%). Among the encounters in which an antibiotic was prescribed, 29.1% included a fluoroquinolone prescription. A subset of 100 patients from this population were reviewed and assessed for appropriateness based on symptoms, comorbidities, allergies, and previous urinary isolates. The prescribed drug class was determined appropriate in 40% of the fluoroquinolone cases and in 80% of the nitrofurantoin or sulfamethoxazole/trimethoprim cases. Conclusion Potential strategies that may reduce the inappropriate prescribing of fluoroquinolones in our large academic health system include an EHR alert, regular dissemination of prescriber reports, and additional provider education to facilitate shared decision-making. These results provide a baseline to inform future interventions to reduce inappropriate antibiotic prescribing and to ensure compliance with Joint Commission standards. Disclosures All Authors: No reported disclosures