Colorado's Statewide Antimicrobial Stewardship (AMS) Collaborative: Facilitating Syndrome-Specific Interventions for Skin and Soft Tissue Infection (SSTI) and Urinary Tract Infection (UTI)

Abstract

Background. In May 2015, the Colorado Hospital Association (CHA) launched a statewide collaborative to engage hospitals in antimicrobial stewardship. Collaborative objectives were to: 1) reduce median treatment durations by 20% for UTIs and SSTIs; 2) reduce broad-spectrum antibiotics (ABX) use by 30% for SSTIs; 3) increase proportion of UTIs meeting the Infectious Disease Society of America (IDSA) definition by 15%; and 4) reduce fluoroquinolone (FQ) use by 30% for UTIs. Methods. Each hospital formed a multi-disciplinary team to implement SSTI- and UTI-specific antimicrobial stewardship interventions tailored to the hospital's needs and resources. SSTIs and UTIs were selected because they are common in acute care and associated with frequent antibiotic overuse. Resources provided to the teams included evidence-based diagnosis and prescribing guidelines, an annual in-person meeting, monthly webinars, twice-monthly coaching newsletters, and access to local and national AMS experts. Each hospital was also asked to review and submit data on the management of 80 cases of SSTI and UTI during 2014 (baseline period) and 20 cases each quarter after the intervention was started in October 2015. During the intervention, quarterly summaries with individual hospital performance data and benchmarking to peer hospitals were disseminated to each team. Results. Twenty-seven acute care hospitals (inpatient bed range 15-567) were recruited to participate in the collaborative. Data were submitted for 722 SSTI and 1530 UTI cases during the baseline period and for 360 SSTI and 886 UTI cases during the first two quarters of the intervention. These early data demonstrate that among SSTI cases, the proportion treated with ABX with broad Gram-negative activity declined from 61% to 53%, and the median duration of therapy decreased from 13 days to 11 days (figure). Among UTI cases, the proportion meeting clinical criteria for UTI increased from 42% to 45%, and the use of FQs declined from 49% to 43%. Conclusion. A statewide AMS collaborative facilitating syndrome-specific interventions for SSTI and UTI is a feasible approach to engage a large number of hospitals in antimicrobial stewardship. Early data suggest the interventions have positively influenced ABX prescribing patterns. (Figure Presented).