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Male veterans with complicated urinary tract infections: Influence of a patient-centered antimicrobial stewardship
James F Carbo1, Christine A Ruh2, Kari E Kurtzhalts1
1Veterans Affairs Western New York Healthcare System, Buffalo, NY.
Background:
The influence of antimicrobial stewardship programs (ASPs) on outcomes in male veterans treated for complicated urinary tract infection has not been determined.
Methods:
This was a retrospective cohort study encompassing the study period January 1, 2005-October 31, 2014, which was conducted at a 150-bed Veterans Affairs Healthcare System facility in Buffalo, NY. Male veterans admitted for treatment of complicated urinary tract infection were identified using ICD-9-CM codes. Outcomes before and after implementation of a patient-centered ASP, including duration of antibiotic therapy, length of hospitalization, readmission within 30 days, and Clostridium difficile infection were compared. Interventions resulting from the ASP were categorized.
Results:
Of the 1,268 patients screened, 241 met criteria for inclusion in the study (n = 118 and n = 123 in the pre-ASP and ASP group, respectively). Duration of antibiotic therapy was significantly shorter in the ASP group (10.32 days vs 11.96 days; P < .0001), as was length of hospitalization (5.76 days vs 6.76 days; P = .015). There was no difference in 30-day readmission. A total of 170 interventions were identified that resulted from the ASP (1.39 interventions per patient).
Conclusions:
ASPs may be useful to improve clinical outcomes in men with complicated urinary tract infection. Implementation of an ASP was associated with significant decreases in duration of antibiotic therapy and length of hospitalization, without adversely affecting 30-day readmission rates.
Insights
Antimicrobial stewardship programs (ASPs) shortened antibiotic therapy and hospital stays for male veterans with complicated urinary tract infections. These programs improved outcomes without increasing readmission rates.
Area of Science:
- Infectious Diseases
- Healthcare Management
- Clinical Outcomes
Background:
- Complicated urinary tract infections (cUTIs) in male veterans require effective treatment strategies.
- The impact of antimicrobial stewardship programs (ASPs) on cUTI outcomes in this population was previously undetermined.
Purpose of the Study:
- To evaluate the influence of a patient-centered ASP on clinical outcomes for male veterans with cUTI.
- To compare outcomes before and after ASP implementation.
Main Methods:
- Retrospective cohort study at a Veterans Affairs facility (2005-2014).
- Included male veterans treated for complicated urinary tract infection.
- Compared outcomes including antibiotic duration, hospitalization length, and readmission rates pre- and post-ASP.
Main Results:
- ASP implementation was associated with significantly shorter antibiotic therapy duration (10.32 vs 11.96 days) and hospitalization length (5.76 vs 6.76 days).
- No significant difference in 30-day readmission rates was observed.
- 170 ASP interventions were identified (1.39 per patient).
Conclusions:
- Antimicrobial stewardship programs show promise for improving clinical outcomes in men with complicated urinary tract infections.
- ASP implementation led to reduced antibiotic exposure and shorter hospital stays without negatively impacting readmission rates.
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