Development, Implementation and Evaluation of Novel Strategies to Reduce Inappropriate Antibiotic Use

This study addresses a major unmet need for the development and evaluation of evidence-based algorithms to reduce inappropriate use of antimicrobials in healthcare facilities. Urinary tract infections (UTIs) offer a tremendous opportunity to address the problem of inappropriate antimicrobial use because they are common, preventable, and often treated unnecessarily. We propose to evaluate whether an evidence-based algorithm to prevent and appropriately manage UTIs will safely decrease antimicrobial use and reduce rates of antimicrobial resistance in a healthcare system. Our goal is to develop an effective intervention that will reduce the development of antimicrobial-resistant infections and serve as a model for other healthcare institutions. The specific aims of this proposal are: 1) To determine the frequency of, reasons for, and adverse effects of inappropriate treatment of UTI in a healthcare system; 2) To correlate the duration of antimicrobial treatment with risk for emergence and dissemination of antimicrobial-resistant pathogens; and 3) To determine if an algorithm-based intervention for prevention and management of UTI, in combination with an intervention to decrease unnecessary use of fluoroquinolones, will safely decrease fluoroquinolone and total antimicrobial use and reduce rates of antimicrobial resistance in a healthcare system.