1747. Emergency Department Antimicrobial Stewardship Intervention Bundle to Optimize Antibiotic Prescribing in Urinary Tract Infections and Skin and Soft Tissue Infections

Abstract

Background Emerging literature has demonstrated a positive impact of emergency department (ED)-focused antimicrobial stewardship initiatives on antibiotic prescribing. To date, the majority of interventions focus on urinary tract infections (UTI) and few evaluate electronic medical record (EMR) integration. Methods This retrospective, quasi-experimental study was conducted at five EDs within a large-community health system. An antimicrobial stewardship intervention bundle was implemented in February 2022, consisting of ED-specific discharge antibiotic order sets for UTI and skin and soft tissue infections (SSTI) and education to ED prescribers and pharmacists. Adult patients receiving an ED discharge antibiotic prescription associated with a UTI or SSTI ICD10 code were included. The primary outcome was the percentage of prescriptions matching discharge order set antibiotic regimens for UTI and SSTI in the 2-month pre- and post-implementation periods. Secondary outcomes included evaluation of primary outcome indications (UTI or SSTI), use of recommended agents or durations of therapy, use of combination therapy (SSTI only), and rate of 30-day hospital admission. Results The implementation of this multi-intervention stewardship bundle was associated with a significant initial improvement in the percentage of prescriptions matching discharge order set recommendations for UTI and SSTI (30.9% vs. 35%, P = 0.04). There was a significant improvement in UTI prescribing (54.9% vs. 61.7%, P = 0.01), but the same benefit was not demonstrated for SSTI (6.2% vs. 3.6%, P = 0.04). A significant improvement was also observed in the use of recommended durations of therapy (34% vs. 38.5%, P = 0.023). No significant difference was observed in use of indication recommended agents (75.7% vs. 77.1%, P = 0.43), use of inappropriate combination therapy for SSTI (31.7% vs.26.3%, P = 0.07), or 30-day hospital admission (6% vs. 5%, P = 0.33). Conclusion This novel multi-intervention ED antimicrobial stewardship bundle was associated with overall immediate improvements in antibiotic prescribing for discharged patients. Future directions of research will include evaluation of methods to improve SSTI prescribing, implementation of prescriber data feedback, and expansion to additional indications. Disclosures All Authors: No reported disclosures.