The Role of a Stewardship Pharmacist in Treating UTIs in the Outpatient Setting

A health system piloted a program that explored having an infectious disease pharmacist aid in guiding treatment.

Urinary tract infections (UTI) continue to be one of the most common bacterial infections. There have been studies demonstrating that the addition of a ambulatory antimicrobial stewardship pharmacist (ASP) can have a positive impact on antibiotic prescribing practices for UTIs.

Novant Health in North Carolina began a pilot program with a UTI care pathway to guide empiric treatment, and utilizing an infectious disease pharmacist to provide education, feedback, and support for select outpatient clinics.

A team of investigators did a retrospective study within 2 Novant outpatient clinics to determine if it was in fact helping with outcomes. “The composite endpoint being appropriate antibiotic selection, dose, and duration of UTI treatment. The secondary endpoints included an analysis of each component of the primary endpoint, incidence of provider-initiated drug information questions, incidence of organism-empiric antibiotic mismatch, and incidence of mismatches that were not prescribed appropriate definitive therapy,” the investigators wrote. “A subgroup analysis of appropriate management at each clinic site was performed.”

There was a total of 211 patients with 126 of them in the pre-ASP group and 85 in the post-ASP group. The majority of the patients were prescribed nitrofurantoin.

The investigators noted, “appropriate UTI management occurred in 66 (61%) of the pre-ASP group compared to 46 (62%) of the post-ASP group (p=0.83). No significant difference was seen in appropriate selection, dose, or duration between the groups (p=0.34; p=0.39; p=0.75). There were 11 provider-initiated questions and 36 organism-empiric antibiotic mismatches (17 in the pre-ASP, 19 in the post-ASP) with only 1 mismatch not prescribed appropriate definitive therapy.”

They also found there was no difference in appropriate UTI management in the clinic A cohort (pre-ASP 83%; post-ASP 83%; p=1). However, the investigators found appropriate UTI management significantly increased in clinic B cohort (pre-ASP 16%; post-ASP 42%; p=0.01).

“Improvement in appropriate UTI management was observed after implementation of a UTI care pathway and an infectious diseases pharmacist pilot at the outpatient clinics,” the investigators wrote.

The study, “Ambulatory Antimicrobial Stewardship Impact on Treatment of Urinary Tract Infections,” was presented at the 24th Annual Making a Difference in Infectious Disease (MAD-ID) Meeting 2022 in Orlando, Florida from May 18-21.

Contagion spoke to study coauthor Melanie Schrack, PharmD, at the MAD-ID meeting who provided insights on the study and how ASPs can help guide treatment.