1110. Outcomes Following Implementation of a Urine Culture

Background Antimicrobials are often inappropriately initiated for asymptomatic bacteriuria (ASB). At our institution, urinalysis (U/A) and urine culture (UCx) are ordered simultaneously, leading to an increased rate of catheter-associated UTI (CAUTI) diagnosis and antimicrobial initiation. A UCx algorithm was implemented in the medical intensive care unit (MICU) to guide the appropriate ordering of UCx in patients with foley catheters. The purpose of this study was to assess the impact of this UCx algorithm paired with nursing and prescriber education on overall patient outcomes. Methods This was a single-center, pre- and post-analysis of patients admitted to the MICU with an order for a U/A and/or UCx for suspected UTI. Patients were excluded if they had a suspected co-infection from another source, absence of foley catheter or UCx drawn prior to MICU admission. The pre-implementation phase was November 1, 2017 to April 31, 2018, and the post-phase was May 1, 2018 to October 31, 2018. The primary objective was to compare the incidence of CAUTI between pre- and post-implementation phases. Secondary objectives included rate of adherence to the algorithm, number of UCx ordered, rate and days of antimicrobial therapy for ASB, duration of catheterization and 30-day mortality between pre- and post-implementation phase. Results There were 94 patients in the pre-phase and 77 patients in the post-phase. Baseline characteristics were similar between groups, except a greater proportion of patients in the pre-phase had a catheter prior to admission (12.8% vs. 2.6%; P = 0.02). Incidence of CAUTI decreased following algorithm implementation (16% vs. 6.5%; P = 0.05). Complete algorithm adherence was 2.6%, whereas partial adherence was 49.4%. Number of UCx ordered were 126 (comprising 100% of patients) and 76 (comprising 86% of patients) in the pre- and post-phase, respectively. Antimicrobial therapy for ASB was initiated in 55.3% of patients in the pre-phase vs. 37.7% in the post-phase; P = 0.02. There were no differences in duration of ASB treatment, catheterization or 30-day mortality. Conclusion Implementation of UCx algorithm paired with educational intervention resulted in a significant decrease in CAUTI and ASB treatment. Additional interventions may be necessary to optimize adherence to the algorithm. Disclosures All authors: No reported disclosures.