P-1771. Impact of a Multistep Urinary Tract Infection-Focused Disease State Stewardship Initiative on the Treatment of Asymptomatic Urinary Presentations

Abstract Background Asymptomatic bacteriuria (ASB) is often overtreated, risking patient harm through unnecessary antimicrobial use and fostering antimicrobial resistance. This study assessed the impact of a multistep urinary tract infection (UTI)-focused stewardship intervention by comparing the incidence of asymptomatic urinary presentation (AUP) treatment before and after implementation. Methods This retrospective quasi-experimental study included patients > 18 years at University of Kentucky HealthCare who received antimicrobial therapy with a urinalysis (UA) and/or urine culture (UC) collected for a presumed UTI between January 2023 to March 2023 (pre-implementation) and January 2024 to March 2024 (post-implementation). The steps implemented sequentially as part of the initiative included order set optimization with removal of unnecessary UAs, institution wide education, development of a new UA order with reflex to UC, and prospective audit and feedback. Our primary outcome was the incidence of AUP treatment. Results A total of 381 patients were evaluated with 204 in the pre-implementation group and 177 in the post-implementation group. Following implementation there was a trend toward decreased treatment for AUPs (42.2% vs. 35.0%, p=0.154). In the post-implementation group, fewer patients were treated for a UTI with altered mental status as the only reported symptom (10.8% vs. 5.1%, p=0.042). Moreover, overall adherence to guidelines significantly improved in the post-implementation phase (28.4% vs. 42.9%, p=0.003). There was also a notable enhancement in culture-targeted definitive therapy selection in the post-implementation group (20.1% vs. 37.3%, p < 0.001) as well as the number of patients who received appropriate antibiotic durations for a UTI in the post-implementation group (38.7% vs. 53.1%, p= 0.005). Conclusion The implementation of a UTI-focused disease state stewardship initiative led to improvements in overall guideline adherence, culture-targeted definitive therapy selection, and therapy duration. Although further reductions in treatment of AUPs are still needed, these results suggest that a UTI-focused initiative improves overall UTI management and decreases unnecessary antimicrobial use. Disclosures Sarah Cotner, PharmD, BCPS, Gilead Sciences, Inc: Advisor/Consultant