Improving outpatient antimicrobial stewardship through a urine culture follow-up program utilizing pharmacist-led...

To compare clinical outcomes for patients with a positive urine culture who were prescribed antibiotics vs those who were not prescribed antibiotics, as determined by pharmacist-conducted symptom evaluation via an outpatient culture follow-up program.

This retrospective cohort study included adult female patients with a positive urine culture collected at an emergency department (ED) or urgent care (UC) visit who were contacted by a pharmacist for follow-up and symptom assessment. Patients with urinary symptoms had antibiotic therapy initiated or changed (standard of care [SOC]); however, patients without symptoms did not receive a new antibiotic prescription (intervention). The primary objective was to compare treatment for symptomatic urinary tract infection within 30 days of follow-up between the groups. Secondary objectives included evaluating pharmacist workload and comparing adverse events and Clostridioides difficile infection within 30 days between the groups.

A total of 214 patients were included (97 in the SOC group and 117 in the intervention group). At their initial visit, 83.5% of patients in the SOC group reported urinary symptoms vs 53% of patients in the intervention group (P < 0.001). Empiric antibiotic prescribing was similar between the groups (SOC, 37.1%; intervention, 25.6%; P = 0.392). There was no difference in treatment of symptomatic urinary tract infection within 30 days of follow-up (SOC, 14.4%; intervention, 11.1%; P = 0.466). Follow-up occurred on average 2.5 days after discharge, requiring a median of 1 contact attempt and 15 minutes to conduct the call and documentation.

Our findings support nonprescribing of antibiotics at follow-up for asymptomatic patients, despite a positive urine culture, as an appropriate stewardship intervention for ED and UC patients to prevent unnecessary antibiotic exposure.