Improved empiric antibiotic prescribing for acute cystitis with use of local urinary antibiogram and clinical decision support system

DASON Fellow Dr. Chris Shoff led a team of faculty from the Infectious Diseases Divisions of both Duke University Medical Center and the Durham VA Hospital to show improved emperic antibiotic prescribing for acute cystitis with use of local urinary antibiograms and clinical support systems. 

Acute cystitis accounts for a significant proportion of ambulatory care visits every year in the United States. Empiric antibiotic selection varies widely among providers, even those working within the same health system. Current Infectious Diseases Society of America guidelines emphasize the use of local susceptibility data for determining initial antimicrobial therapy.1 Previous findings suggest that site-specific antibiograms (ie, urine, blood, etc) may result in improved empirical therapy.2 We collated a local urinary antibiogram to promote recommended empiric antibiotic therapies for the treatment of cystitis. A clinical decision support system (CDSS) and order set were nested within the electronic medical record to encourage guideline-concordant prescribing. Using a quasi-experimental time series analysis, we assessed the impact of this intervention on β-lactam and fluoroquinolone prescribing rates for outpatient acute cystitis.

The research brief can be found in the journal Infection Control & Hospital Epidemiology at NCBI