Creating an Antibiogram for Urinary Tract Infection Treatment in a Federally Qualified Health Center

Written by Aubrey Boegly, Joseph Cipriano, Scott Hirst, & Cynthia Ayres

doi: https://doi.org/10.13178/jnparr.2025.1501.1507

Abstract

Background: Antimicrobial resistance (AMR) is a global crisis requiring urgent action. Antibiograms are widely used in hospitals and large healthcare systems to identify resistance patterns and guide optimal antibiotic prescribing. However, their use in primary care settings remains limited.

Objective: This quality improvement project was to develop an antibiogram within a federally qualified health center (FQHC) by collecting and analyzing urine cultures from patients with suspected urinary tract infections (UTIs).

Methods: The project included retrospective chart reviews, provider education, the implementation of a process change, and post-implementation analysis. Adherence to American Academy of Family Physicians (AAFP) guidelines for UTI treatment, including the use of Nitrofurantoin (Macrobid) for five days or Sulfamethoxazole-trimethoprim (Bactrim) for three days, was also assessed.

Results: Provider education and the evidence-based process change improved knowledge of causative microorganisms and facilitated the use of antibiogram data for treatment decisions after project implementation. In addition, there was an increase in urine culture collection and patient education on UTI prevention. A Chi-square test for independence showed a statistically significant association between the process change and increased urine culture collection, χ2 (1, n = 200) = 19.2, p < .001. The majority of antibiotic prescriptions post-implementation were Bactrim (n = 44) and Macrobid (n = 37).

Conclusion: This quality improvement initiative supports the reduction of AMR and provides a model for creating antibiograms to address other common bacterial infections in primary care settings.

Keywords: antimicrobial resistance, antibiogram, urinary tract infection, UTI, primary care, bacterial infection