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Antimicrobial Stewardship in the ED to Improve UTI

Open Forum Infect Dis; ePub 2018 May 2; Jorgensen, et al

An outcomes-based approach to antimicrobial stewardship programs (ASP) can implement meaningful change to knowledge and attitudes affecting prescribing practices in the emergency department (ED). This according to study that examined the strategies applied by a single institution’s ASP that were successful in improving prescribing practices and outcomes for urinary tract infection (UTI) in the ED. Core strategies included pre-implementation research characterizing the patient population, antimicrobial resistance patterns, prescribing behavior and morbidity related to infection, development and implementation of a UTI treatment algorithm, and early intervention of post-implementation outcomes. Researchers found:

  • A rapid change in prescribing post-implementation with increased empiric nitrofurantoin use and reduced cephalosporin use was observed.
  • First-line use of nitrofurantoin was independently associated with reduced 30-day return visits.
  • Preferential use of nitrofurantoin did not result in higher bug-drug mismatches while 30-day return visits to the ED were stable.


Jorgensen SCJ, Yeung SL, Zurayk M, et al. Leveraging antimicrobial stewardship in the emergency department to improve the quality of urinary tract infection management and outcomes. [Published online ahead of print May 2, 2018]. Open Forum Infect Dis. doi:10.1093/ofid/ofy101.