Integrating an antimicrobial stewardship bundle into advanced urgent care sites.

Objective: Urgent care locations remain a target for antimicrobial stewardship initiatives due to high rates of inappropriate antibiotic prescribing, particularly for respiratory tract infections. This study evaluated the impact of an antimicrobial stewardship bundle at urgent care sites on appropriate antibiotic prescriptions. Design: Retrospective, observational, pre- and post-analysis. Setting: Four advanced urgent care sites affiliated with an academic medical institution. Patients: Urgent care patients evaluated for respiratory tract infections. Intervention: An antimicrobial stewardship bundle including clinician-signed stewardship posters, over-the-counter medication prescription pads, and an educational campaign was introduced to advanced urgent care sites from October to November 2024. Respiratory tract infections were tiered by antibiotic appropriateness (1 = always appropriate; 2 = sometimes appropriate; 3 = never appropriate). Adults with tier 2 or 3 diagnoses from December 2023 to January 2024 (pre-group) and December 2024 to January 2025 (post-group) were included. The primary outcome was proportion of appropriate antibiotic prescriptions. Results: Two hundred and seventy-five patients with tier 2 and tier 3 indications were screened; 200 patients were included. Following implementation of the antimicrobial stewardship bundle, there was no significant difference in rates of appropriate antibiotic prescriptions for tier 2 and tier 3 respiratory infections between the pre- and post-groups (76% vs 74%, respectively; P = 0.68). After implementation, more patients received appropriate antibiotics for tier 2 indications (77% vs 95%; p = 0.13). The most prescribed antibiotic agents amongst both groups were amoxicillin-based antibiotics (15%) and azithromycin (15%). Conclusion: This study highlights challenges and opportunities for outpatient antimicrobial stewardship practices.