{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T14:44:02Z","timestamp":1792680242942,"version":"4.5.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T00:00:00Z","timestamp":1643673600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Urinary tract infections (UTIs) are often misdiagnosed or treated with exceedingly broad-spectrum antibiotics, leading to negative downstream effects. We aimed to implement antimicrobial stewardship (AS) strategies targeting UTI prescribing in the emergency department (ED).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a quasi-experimental prospective AS intervention outlining appropriate UTI diagnosis and management across 3 EDs, within an academic and 2 community hospitals, in North Carolina, United States. The study was divided into 3 phases: a baseline period and 2 intervention phases. Phase 1 included introduction of an ED-specific urine antibiogram and UTI guideline, education, and department-specific feedback on UTI diagnosis and antibiotic prescribing. Phase 2 included re-education and provider-specific feedback. Eligible patients included adults with an antibiotic prescription for UTI diagnosed in the ED from 13 November 2018 to 1 March 2021. Admitted patients were excluded. The primary outcome was guideline-concordant antibiotic use, assessed using an interrupted time-series regression analysis with 2-week intervals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, 8742 distinct patients with 10\u00a0426 patient encounters were included. Ninety-two percent of all encounters (n\u2005=\u20059583) were diagnosed with cystitis and 8.1% with pyelonephritis (n\u2005=\u2005843). There was an initial 15% increase in guideline-concordant antibiotic prescribing in phase 1 compared with the preintervention period (incidence rate ratio [IRR], 1.15; 95% confidence interval [CI], 1.03\u20131.29). A significant increase in guideline-concordant prescriptions was seen with every 2-week interval during phase 2 (IRR, 1.03; 95% CI, 1.01\u20131.04).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This multifaceted AS intervention involving a guideline, education, and provider-specific feedback increased guideline-concordant antibiotic choices for treat-and-release patients in the ED.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciac073","type":"journal-article","created":{"date-parts":[[2022,1,28]],"date-time":"2022-01-28T20:17:31Z","timestamp":1643401051000},"page":"1194-1200","source":"Crossref","is-referenced-by-count":10,"title":["Impact of Education and Data Feedback on Antibiotic Prescribing for Urinary Tract Infections in the Emergency Department: An Interrupted Time-Series Analysis"],"prefix":"10.1093","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2194-8581","authenticated-orcid":false,"given":"Cara L","family":"Nys","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Duke University Hospital , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Duke University Hospital , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Funaro","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Duke University Hospital , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J","family":"Shoff","sequence":"additional","affiliation":[{"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca G","family":"Theophanous","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Surgery, Duke University Hospital , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine A","family":"Staton","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Surgery, Duke University Hospital , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Mando-Vandrick","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Duke University Hospital , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Toler","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Duke Regional Hospital , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Shroba","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Duke Raleigh Hospital , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas A","family":"Turner","sequence":"additional","affiliation":[{"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beiyu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University School of Medicine , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui Jie","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University School of Medicine , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebekah W","family":"Moehring","sequence":"additional","affiliation":[{"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebekah H","family":"Wrenn","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Duke University Hospital , Durham, North Carolina , USA"},{"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,2,1]]},"reference":[{"key":"2022093020243380100_CIT0001","doi-asserted-by":"crossref","DOI":"10.15620\/cdc:82532","volume-title":"Antibiotic resistance threats in the United States, 2019","author":"Centers for Disease Control and 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