1846. Outpatient Antibiotic Use in Viral Acute Upper Respiratory Tract Infections at a Military Treatment Facility: A Target for Stewardship Intervention

Background. Antimicrobial stewardship programs (ASP) can be effective at reducing inappropriate antimicrobial usage that contributes to antimicrobial resistance and adverse medical outcomes. However, developing effective ASP remains an important challenge, especially in the ambulatory setting. Outpatient antibiotic prescriptions for acute respiratory tract infections (ARI) are one area in which inappropriate prescribing has been previously described, and are a potential ASP target. Methods. In effort to develop targeted interventions, antibiotic prescribing for viral ARI was examined in primary care outpatient clinics and the emergency department (ED) of a large military medical center using the military health system management and analysis reporting tool. Adult and pediatric patient encounters from calendar year 2017 were included using 23 relevant ICD-10 diagnostic codes for viral ARIs; those with concurrent diagnoses of asthma/COPD, pneumonia, chronic sinusitis, streptococcal pharyngitis, or otitis media were excluded. Frequencies of ARI diagnosis and antibiotic dispersal were calculated. Results. Among the 6,354 patients diagnosed with ARI in 2017, 728 (11.5%) were prescribed an unnecessary antibiotic with the highest frequency of such prescriptions in those over the age of 45, females, and family members of service members. Diagnoses most associated with unnecessary antibiotic prescribing were uncomplicated bronchitis (39%) and pharyngitis (22%) for adult medicine; acute rhinosinusitis (40%) and pharyngitis (19%) for pediatric medicine; and uncomplicated bronchitis (33%) for the ED. This increased in the winter months when viral ARI are common. Approximately $22,000 was spent on unnecessary antimicrobial prescriptions with the largest contribution from macrolides. Conclusion. Based on our analysis, we developed multipronged interventions at facility, clinic, and provider levels. Planned interventions will include interval facility-wide ASP updates with increased frequency during winter months and biannual educational sessions with staff emphasizing clinic-specific diagnoses associated with inappropriate antibiotic prescribing. Program success will be assessed with interval analysis of antibiotic prescribing after intervention implementation.