Eric Landry1, Linda Sulz2, Ali Bell3, Lane Rathgeber4, Heather Balogh5. 1. , BSP, ACPR, was, at the time of this study, a pharmacy practice resident (2011/2012) with the Regina Qu'Appelle Health Region, Regina, Saskatchewan, and completed this project in partial fulfillment of the residency requirements. He is currently with the College of Pharmacy and Nutrition at the University of Saskatchewan, Saskatoon, Saskatchewan, as Coordinator of the Medication Assessment Centre. 2. , BSP, PharmD, is with the Regina Qu'Appelle Health Region, Regina, Saskatchewan. 3. , MA, MSc, is with the Regina Qu'Appelle Health Region, Regina, Saskatchewan. 4. , BSc, MD, CCFP(EM), is with the Regina Qu'Appelle Health Region, Regina, Saskatchewan. 5. , BSP, is with the Regina Qu'Appelle Health Region, Regina, Saskatchewan.
Abstract
BACKGROUND: Overuse of fluoroquinolone antibiotics is associated with outbreaks of methicillin-resistant Staphylococcus aureus and of Clostridium difficile-associated diarrhea and increasing resistance in gram-negative organisms. Over the past decade, resistance of Escherichia coli to ciprofloxacin has increased in the Regina Qu'Appelle Health Region. In August 2011, an exploratory audit of the Regina General Hospital (RGH) emergency department showed that 20% of new antibiotic orders were for fluoroquinolones, and 60% of these new fluoroquinolone orders were for ciprofloxacin. It was postulated that ciprofloxacin was predominantly prescribed for outpatients with urinary tract infection. OBJECTIVE: To develop, implement, and evaluate a best-practice algorithm for the empiric treatment of uncomplicated urinary tract infection in the RGH emergency department, as part of an educational initiative for emergency physicians. METHODS: A literature review was conducted and local antibiogram data were analyzed to establish a best-practice algorithm for treatment of uncomplicated urinary tract infection in outpatients seen in the emergency department. A chart review was conducted from January to March 2011 to establish a baseline of empiric antibiotic use. An educational strategy targeting emergency physicians described changes in antibiotic resistance patterns in the health region, principles of antimicrobial stewardship, drivers of resistance, and the results of a literature review of best practice for urinary tract infection in outpatients. A post-intervention audit was conducted from January to March 2012 to determine changes in practice. RESULTS: Comparison of results from the post-intervention audit with baseline data showed that adherence to best practice increased significantly, from 41% (39/96) before the intervention to 66% (50/76) after the intervention (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.51-5.25; p < 0.001). There was also a significant change in overall antibiotic selection (OR 0.25, 95% CI 0.11-0.58; p < 0.001). Further analysis suggested that this significant change was driven by a decrease in use of ciprofloxacin, from 32% (31/96) to 11% (8/76). CONCLUSION: Creation of a best-practice algorithm and education focused on emergency physicians significantly increased adherence to best practice and optimized antibiotic prescribing for outpatients with uncomplicated urinary tract infection by limiting overuse of fluoroquinolones, primarily ciprofloxacin.
BACKGROUND: Overuse of fluoroquinolone antibiotics is associated with outbreaks of methicillin-resistant Staphylococcus aureus and of Clostridium difficile-associated diarrhea and increasing resistance in gram-negative organisms. Over the past decade, resistance of Escherichia coli to ciprofloxacin has increased in the Regina Qu'Appelle Health Region. In August 2011, an exploratory audit of the Regina General Hospital (RGH) emergency department showed that 20% of new antibiotic orders were for fluoroquinolones, and 60% of these new fluoroquinolone orders were for ciprofloxacin. It was postulated that ciprofloxacin was predominantly prescribed for outpatients with urinary tract infection. OBJECTIVE: To develop, implement, and evaluate a best-practice algorithm for the empiric treatment of uncomplicated urinary tract infection in the RGH emergency department, as part of an educational initiative for emergency physicians. METHODS: A literature review was conducted and local antibiogram data were analyzed to establish a best-practice algorithm for treatment of uncomplicated urinary tract infection in outpatients seen in the emergency department. A chart review was conducted from January to March 2011 to establish a baseline of empiric antibiotic use. An educational strategy targeting emergency physicians described changes in antibiotic resistance patterns in the health region, principles of antimicrobial stewardship, drivers of resistance, and the results of a literature review of best practice for urinary tract infection in outpatients. A post-intervention audit was conducted from January to March 2012 to determine changes in practice. RESULTS: Comparison of results from the post-intervention audit with baseline data showed that adherence to best practice increased significantly, from 41% (39/96) before the intervention to 66% (50/76) after the intervention (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.51-5.25; p < 0.001). There was also a significant change in overall antibiotic selection (OR 0.25, 95% CI 0.11-0.58; p < 0.001). Further analysis suggested that this significant change was driven by a decrease in use of ciprofloxacin, from 32% (31/96) to 11% (8/76). CONCLUSION: Creation of a best-practice algorithm and education focused on emergency physicians significantly increased adherence to best practice and optimized antibiotic prescribing for outpatients with uncomplicated urinary tract infection by limiting overuse of fluoroquinolones, primarily ciprofloxacin.
Authors: Timothy H Dellit; Robert C Owens; John E McGowan; Dale N Gerding; Robert A Weinstein; John P Burke; W Charles Huskins; David L Paterson; Neil O Fishman; Christopher F Carpenter; P J Brennan; Marianne Billeter; Thomas M Hooton Journal: Clin Infect Dis Date: 2006-12-13 Impact factor: 9.079
Authors: James A Karlowsky; Daryl J Hoban; Melanie R Decorby; Nancy M Laing; George G Zhanel Journal: Antimicrob Agents Chemother Date: 2006-06 Impact factor: 5.191
Authors: Annie Wong-Beringer; Lee H Nguyen; Michelle Lee; Kimberly A Shriner; Jean Pallares Journal: Pharmacotherapy Date: 2009-06 Impact factor: 4.705
Authors: Kalpana Gupta; Thomas M Hooton; Kurt G Naber; Björn Wullt; Richard Colgan; Loren G Miller; Gregory J Moran; Lindsay E Nicolle; Raul Raz; Anthony J Schaeffer; David E Soper Journal: Clin Infect Dis Date: 2011-03-01 Impact factor: 9.079
Authors: D M Shlaes; D N Gerding; J F John; W A Craig; D L Bornstein; R A Duncan; M R Eckman; W E Farrer; W H Greene; V Lorian; S Levy; J E McGowan; S M Paul; J Ruskin; F C Tenover; C Watanakunakorn Journal: Clin Infect Dis Date: 1997-09 Impact factor: 9.079
Authors: Marcus J Zervos; Ellie Hershberger; David P Nicolau; David J Ritchie; Lori K Blackner; Elizabeth A Coyle; Andrew J Donnelly; Stephen F Eckel; Robert H K Eng; Alexandra Hiltz; Arpi G Kuyumjian; William Krebs; Angee McDaniel; Patricia Hogan; Teresa J Lubowski Journal: Clin Infect Dis Date: 2003-11-20 Impact factor: 9.079
Authors: Sarah C J Jorgensen; Samantha L Yeung; Mira Zurayk; Jill Terry; Maureen Dunn; Paul Nieberg; Jean Pallares; Annie Wong-Beringer Journal: Open Forum Infect Dis Date: 2018-05-02 Impact factor: 3.835
Authors: Kevin Lin; Yorgo Zahlanie; Jessica K Ortwine; Norman S Mang; Wenjing Wei; L Steven Brown; Bonnie C Prokesch Journal: Open Forum Infect Dis Date: 2020-05-21 Impact factor: 3.835