From the 2024 HVPA National Conference
David Reynoso MD, PhD (University of Texas Medical Branch)
Rationale:
National clinical practice guidelines recommend avoidance of fluoroquinolones for simple cystitis. First-line, recommended antibiotics include nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole.
Interventions:
System-wide education, clinical pathway / guideline dissemination, feedback to provider groups, changing urine culture order set to include questions (targeting inappropriate urine culture orders).
Baseline (%) outpatient encounters where fluoroquinolones were ordered for UTI diagnoses = 14% of UTI encounters per month in FY22. Goal decrease was met with only 9% fluoroquinolone use in August 2023. Currently <6.5% in January 2024.
Corollary benefits:
Urine cultures ordered (monthly) have decreased significantly with implementation of order questions, leading to decreased inappropriate treatment of asymptomatic bacteriuria. Improved / stabilized fluoroquinolone resistance in urine bacteria.