2228. Antibiotic Appropriateness for UTI Treatment on Monday vs Friday in a NYC Hospital ED

Abstract

Abstract Background Urinary tract infections (UTI) are common and often lead to an antibiotic prescription. Prior studies have shown that antibiotic prescriptions can vary between weekdays and weekends. Methods This is a retrospective case series of female patients ≥18 years with simple cystitis presenting to the ED between 2019 to 2021 in a NYC community hospital. Our primary objective was to determine how often the appropriate antibiotic was prescribed and compare this between Monday and Friday. Antibiotic appropriateness was defined using the 2011 Infectious Disease Society of America clinical practice guidelines for acute uncomplicated cystitis. Criteria included antibiotic selection, dose, frequency, and duration. Per the NYC outpatient UTI antibiogram, Amoxicillin, Ampicillin, Ciprofloxacin, and TMP/SMX were not appropriate empiric therapies. Categorical data is reported as counts (%) and compared with Chi-square; age (nonparametric) is reported as median (range) and compared with Mann-Whitney. Sample size calculation estimated that 71 subjects were needed on each day to detect an effect size of 20% difference in our primary outcome (90% antibiotic appropriateness on Monday and 70% on Friday) with 80% power and an alpha error of 0.05. Results 160 subjects were included, 80 seen on Mondays and 80 seen on Fridays. Demographics were similar between groups, except for antibiotic allergies (Table 1). There was no difference between appropriate antibiotics prescribed on Mondays compared to Fridays, 54/80 (67.5%) vs 60/80 (75%) (p-value = 0.29). Failure to meet criteria for appropriateness was due to inappropriate prescription duration (44/160) or selection (14/160). All prescriptions met criteria for dose and frequency. There was no difference in antibiotic selection, dose, frequency, or duration of prescription on Monday vs Friday (Table 2). More urine cultures were collected on Mondays (62/80) vs Fridays (49/80) (p =.03). Conclusion 1 in 3 patients were prescribed inappropriate antibiotics for simple cystitis, though there was no difference between Mondays and Fridays. Inappropriate antibiotic duration and differences in urine culture collection indicate an inconsistent approach to treatment and missed opportunity to course correct in cases of pathogen resistance. Disclosures Cara Grimes, MD, MAS, Johnson and Johnson: Expert Testimony|Provepharm, Inc: Advisor/Consultant.