IntroductionUrgent care centers represent a high-volume outpatient setting where antibiotics are prescribed frequently but resources for antimicrobial stewardship may be scarce. In 2015, our pharmacist-led Emergency Department (ED) culture follow-up program was expanded to include two urgent care (UC) sites within the same health system. The UC program is conducted by ED and infectious diseases clinical pharmacists as well as PGY1 pharmacy residents using a collaborative practice agreement (CPA). The purpose of this study was to describe the pharmacist-led UC culture follow-up program and its impact on pharmacist workload.MethodsThis retrospective, descriptive study included all patients discharged to home from UC with a positive culture from any site resulting between 1 January and 31 December 2016. Data collected included the culture type, presence of intervention, and proportion of interventions made under the CPA. Additionally, pharmacist workload was reported as the number of call attempts made, new prescriptions written, and median time to complete follow-up per patient. Data were reported using descriptive statistics.ResultsA total of 1461 positive cultures were reviewed for antibiotic appropriateness as part of the UC culture follow-up program, with 320 (22%) requiring follow-up intervention. Culture types most commonly requiring intervention were urine cultures (25%) and sexually transmitted diseases (25%). A median of 15 min was spent per intervention, with a median of one call (range 1–6 calls) needed to reach each patient. Less than half of patients required a new antimicrobial prescription at follow-up.ConclusionA pharmacist-led culture follow-up program conducted using a CPA was able to be expanded to UC sites within the same health system using existing clinical pharmacy staff along with PGY1 pharmacy residents. Service expansion resulted in minimal increase in pharmacist workload. Adding UC culture follow-up services to an existing ED program can allow health systems to expand antimicrobial stewardship initiatives to satellite locations.

In the original publication, the data labels have been inverted in Figure 1. The corrected figure is given here.

Background The procalcitonin (PCT) assay is FDA-approved to help guide antimicrobial treatment of respiratory tract infections, however, conflicting data exist regarding its impact on shortening durations of therapy. The purpose of this study was to compare the impact of PCT to a targeted audit-and-feedback (TAF) strategy on prescribed antibiotic durations of therapy for community-acquired pneumonia (CAP). Methods A retrospective cohort study was conducted at two community teaching hospitals, one implementing PCT with routine audit-and-feedback and one implementing a TAF strategy recommending 5 days of therapy for uncomplicated CAP. The primary objective of this study was to compare the impact of PCT implementation to TAF implementation on durations of therapy prescribed for suspected CAP. Secondary objectives included comparing length of stay, 30-day readmission, mortality, and rates of Clostridioides difficile. Adult inpatients with an antibiotic ordered with an indication of pneumonia were eligible for inclusion. Those who were critically ill, immunocompromised, had concurrent infections, were made comfort care, discharged or expired within 48 hours were excluded. Results 311 patients were included (Pre-TAF n=80, Pre-PCT n=80, Post-TAF n=80, Post-PCT n=71). Average duration of therapy prescribed for CAP at baseline was similar between groups, Pre-TAF 7.0 days vs. Pre-PCT 7.8 days (p=0.1). After implementation of the respective interventions, there remained no difference in the average duration of therapy between groups, Post-TAF 5.5 days vs. Post-PCT 5.4 days (p=0.8). Both PCT and TAF strategies demonstrated significant improvement in prescribed durations for CAP between their respective Pre- and Post-intervention groups (p< 0.001 and p=0.002, respectively). The PCT protocol was followed 41% of the time in the Post-PCT group. There were no differences in readmission, mortality, or C. difficile between groups. Conclusion PCT and TAF were equally effective antimicrobial stewardship strategies in reducing total days of antibiotic therapy prescribed for CAP with no differences observed in patient outcomes. Disclosures All Authors: No reported disclosures

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Background Antipseudomonal antibiotics are often used to treat community-acquired intra-abdominal infections (CA-IAIs) despite common causative pathogens being susceptible to more narrow-spectrum agents. The purpose of this study was to compare treatment-associated complications in adult patients treated for CA-IAI with antipseudomonal versus narrow-spectrum regimens. Methods This retrospective cohort study included patients >18 years admitted for CA-IAI treated with antibiotics. The primary objective of this study was to compare 90-day treatment-associated complications between patients treated empirically with antipseudomonal versus narrow-spectrum regimens. Secondary objectives were to compare infection and treatment characteristics along with patient outcomes. Subgroup analyses were planned to compare outcomes of patients with low-risk and high-risk CA-IAIs and patients requiring surgical intervention versus medically managed. Results A total of 350 patients were included: antipseudomonal, n=204; narrow spectrum, n=146. There were no differences in 90-day treatment-associated complications between groups (antipseudomonal 15.1% vs narrow spectrum 11.3%, P=.296). In addition, no differences were observed in hospital length of stay, 90-day readmission, Clostridiodes difficile, or mortality. In multivariate logistic regression, treatment with a narrow-spectrum regimen (odds ratio [OR], 0.75; 95% confidence interval, 0.39–1.45) was not independently associated with the primary outcome. No differences were observed in 90-day treatment-associated complications for (1) patients with low-risk (antipseudomonal 15% vs narrow spectrum 9.6%, P=.154) or high-risk CA-IAI (antipseudomonal 15.8% vs narrow spectrum 22.2%, P=.588) or (2) those who were surgically (antipseudomonal 8.5% vs narrow spectrum 9.2%, P=.877) or medically managed (antipseudomonal 23.1 vs narrow spectrum 14.5, P=.178). Conclusions Treatment-associated complications were similar among patients treated with antipseudomonal and narrow-spectrum antibiotics. Antipseudomonal therapy is likely unnecessary for most patients with CA-IAI.