Abstract
BackgroundAsymptomatic bacteriuria (ABU) should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice.ObjectiveTo identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU.DesignQuasi-experimental study with a control group.SettingTwo tertiary teaching adult care hospitals.ParticipantsConsecutive patients with positive urine cultures between January 30th and April 17th, 2012 (baseline) and January 30th and April 30th, 2013 (intervention).InterventionIn January 2013, a multifaceted educational intervention based on risk factors identified during the baseline period was provided to medical residents (monthly) on one clinical teaching unit (CTU) at one hospital site, with the CTU of the other hospital serving as the control.ResultsDuring the baseline period, 160/341 (46.9%) positive urine cultures were obtained from asymptomatic patients at the two hospitals, and 94/160 (58.8%) were inappropriately treated with antibiotics. Risk factors for inappropriate use included: female gender (OR 2.1, 95% CI 1.1-4.3), absence of a catheter (OR 2.5, 1.2-5), bacteriuria versus candiduria (OR 10.6, 3.8-29.4), pyuria (OR 2.0, 1.1-3.8), and positive nitrites (OR 2.2, 1.1-4.5). In 2013, only 2/24 (8%) of ABU patients were inappropriately treated on the intervention CTU as compared to 14/29 (52%) on the control CTU (OR 0.10; 95% CI 0.02-0.49). A reduction was also observed as compared to baseline on the intervention CTU (OR 0.1, 0.02-0.7) with no significant change noted on the control CTU (OR 0.47, 0.13-1.7).ConclusionsA multifaceted educational intervention geared towards medical residents with a focus on identified risk factors for inappropriate management of ABU was effective in reducing unnecessary antibiotic use.
Highlights
Bacteria recovered from the genitourinary tract can either be pathogens or mere colonizers and in circumstances where no symptoms are present, patients are diagnosed with asymptomatic bacteriuria (ABU).[1]
Risk factors for inappropriate use included: female gender, absence of a catheter, bacteriuria versus candiduria, pyuria, and positive nitrites
In 2013, only 2/24 (8%) of ABU patients were inappropriately treated on the intervention clinical teaching unit (CTU) as compared to 14/29 (52%) on the control CTU
Summary
Bacteria recovered from the genitourinary tract can either be pathogens or mere colonizers and in circumstances where no symptoms are present, patients are diagnosed with asymptomatic bacteriuria (ABU).[1]. Despite current practice guideline [1] recommendations to refrain from treating patients with ABU except in pregnancy and before urologic procedures, there have been numerous studies suggesting that approximately 50% of patients with ABU are unnecessarily treated with antibiotics.[8,9,10,11] urine cultures are often obtained in settings that are discordant with current guideline recommendations.[12, 13] Inappropriate treatment of ABU results in antibiotic overuse,[14, 15] has been associated with Clostridium difficile infections,[16] increases the risk of symptomatic urinary tract infection (UTI), especially with resistant pathogens, and negatively affects quality of life.[17]. Asymptomatic bacteriuria (ABU) should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; unnecessary treatment of ABU is common in clinical practice
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