Antimicrobial Stewardship Efforts to Improve Management of Uncomplicated Urinary Tract Infections in the Ambulatory Care Setting: a Review

AbstractPurpose of the ReviewOutpatient practice sites prescribe more antibiotics than any other healthcare setting contributing to the increasing rate of drug-resistant infections in the USA. Until the release of the Centers for Disease Control and Prevention ’s Core Elements in 2016, outpatient antimicrobial stewardship (AMS) was largely overlooked. The current review seeks to discuss recent AMS interventions for uncomplicated urinary tract infection (UTI) in the outpatient setting and how they relate to the core elements.Recent FindingsEvidence-based methods for UTI in the outpatient setting include pharmacist-review of urine cultures, provider education, clinical decision support, susceptibility testing, and formulary restriction. These interventions improve guideline adherence and decrease fluoroquinolone use. Additional improvements in outcomes occur when strategies are combined compared to implementation of a single intervention alone.SummaryThere is insufficient evidence to universally recommend one intervention for outpatient practice. Studies are limited by size and design in addition to the need for validation across the spectrum of outpatient settings. Therefore, outpatient stewardship teams should consider which strategy is most feasible and effective for their respective site. Most importantly, it is still unknown if improvements in adherence to clinical guidelines and reductions of fluoroquinolone use translate to meaningful declines in drug resistance.

Source: Current Treatment Options in Infectious Diseases - June 1, 2018 Category: Infectious Diseases Source Type: research