P-1740. Impact of a System Wide Antimicrobial Stewardship Intervention Bundle to Improve Guideline Directed Antibiotics for Urinary Tract Infections

Abstract Background Urinary tract infections (UTIs) are one of the common reasons for antibiotic use across healthcare settings. Across an eleven-hospital system, common urinary pathogens (E. coli, Proteus species, and Klebsiella species) had greater than 80% coverage with cefazolin, which was within 0-8% of ceftriaxone coverage based on the local antibiograms. With increased risk of C. difficile infection and resistance development seen with ceftriaxone, cefazolin was promoted as first line for empiric UTI coverage.Table 1:Outcomes Methods An interrupted time series analysis was performed comparing a pre-intervention group to two phases of stewardship intervention (figure 1). The first intervention included an updated guideline, education, and pharmacist intervention upon order verification recommending guideline directed therapy. Guideline directed options and guideline non-compliant options are highlighted on green and red respectively, on figure 3. The second intervention was cascade reporting (figure 2) for urine culture Enterobacterales susceptibility, which was implemented across sites between 9/2023-1/2024. A generalized linear model with Poisson link was fit to the data. Compliant orders were regressed vs. the denominator of all UTI orders. Multiple models were considered, and the final model selection was based on likelihood ratio testing and the rule of parsimony.Figure 1:Interrupted Time-SeriesWhite = pre-intervention; light gray = intervention 1; dark gray = intervention 2 Results In the four pre-intervention months, guideline compliance across the system was 38.1% (1674/4393), compared to 61.9% (6749/10,903) after intervention 1 was implemented (table 1). The final model suggested that intervention 1 was associated with a nearly 1.5-fold increase in compliance which was sustained over time and suggested that the compliance rate over time increased modestly at around 5% per quarter (figure 1). There was no change in length of stay, risk adjusted length of stay, or 30-day all-cause readmission (table 1).Figure 2:Microbiology Cascade Reporting Workflow Conclusion Guideline update, education, and frontline pharmacist intervention were significantly impactful in improving guideline directed treatment for UTIs. Cascade reporting on urine cultures may help reinforce guideline directed therapy but did not result in substantially different compliance rates from education with frontline pharmacist intervention.Figure 3:Percent of Patients with Empiric Guideline Directed Therapy Orders Disclosures Nathaniel J. Rhodes, PharmD MS, Apothecademy, LLC: Advisor/Consultant