Pharmacist Intervention Effect on Appropriate Management of Urinary Tract Infections: A Quasi-Experimental Cohort Study

Abstract

Purpose: This study serves to evaluate the potential benefit of pharmacist intervention in ensuring appropriate treatment of urinary tract infections (UTI) in adult patients in a community hospital. Methods: This was a single-center, quasi-experimental design, institutional review board (IRB)-approved study comparing antimicrobial use and UTI treatment guidance adherence before (11/2021-1/2022) and after (11/2022-1/2023) pharmacist prospective audit and feedback at a community non-teaching hospital. Inpatients were included if they had a positive urine culture and no other concomitant infection or other exclusion criteria. The primary outcome was time to appropriate antibiotic therapy (as determined by the institutional treatment guidance). Overall appropriateness of empiric antimicrobials was also assessed. Results: A total of 194 patients were included in the study (101 pre-intervention group and 86 post). There was no significant difference in median time to appropriate antimicrobial therapy between groups (20.1 vs 22.6 hours, P = .907) or appropriateness of empiric therapy (50% vs 55%, P = .483). Missing indication and agent choice for higher severity infections were the two most common reasons for inappropriate empiric therapy. A total of 55 pharmacist interventions were made with an overall acceptance rate of 31%. Conclusion: In this study, pharmacist intervention did not have a significant effect on the primary outcome. Promotion of utilization of the UTI order set that aligns with the institution guideline would likely improve the appropriateness of empiric therapy. However, the institutional guidance criteria also seemed to over-recommend broad spectrum agents and may need to be revisited.