A pilot intervention to improve the management of urinary tract infections in outpatient settings

Objective: To describe the implementation of an outpatient UTI intervention and its impact on UTI management. Design: Quasi-experimental retrospective controlled study. Participants: Outpatient clinicians practicing in emergency and primary care settings within 8 Veterans Affairs Medical Centers. Methods: An intervention conducted utilizing the CDC Core Elements Antibiotic Stewardship framework between September 2022 and July 2023. Actions included academic detailing, audit feedback, and updated reflex culture procedures. Logistic regression adjusted for covariates (risk ratio [RR], 95% confidence interval [CI]), and a difference-in-differences (DID) analysis compared multiple UTI management metrics between intervention and control facilities. Results: (%)] 12,688 (8.0) and 4,062 (8.0) within intervention sites and 5,686 (6.3) and 1,920 (6.8) within control sites, respectively [DID aRR 0.97 (0.92, 1.02)]. Appropriate treatment selection for uncomplicated UTI (uUTI) pre/post implementation was 5,994(76.9) and 1,945(79.9), compared to 2,519(74.6) and 977(82.1) within control sites, respectively [DID aRR 0.94 (0.91, 0.98)]. uUTI appropriate treatment duration pre/post implementation was 5,709 (73.3) and 1,927 (79.2), compared to 2,469 (73.1) and 869 (73.0) within control sites, respectively [DID aRR 1.08 (1.03, 1.13)]. No evidence of diagnostic shifting or return GU visits post-implementation was observed. Conclusions: Implementation of an outpatient UTI intervention in a predominantly male population was feasible but marginally effective.