Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention

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In long-term care facilities, treatment of asymptomatic bacteriuria (ASB) is common. However, randomized, controlled trials suggest that such treatment offers no benefit and may promote antimicrobial resistance. For 3 months before and 30 months after instituting an educational intervention, we monitored the appropriateness of urine culture collection and antibiotic treatment based on published guidelines and examined the effect on total antimicrobial use. The intervention included education of nursing staff to discourage the collection of urine cultures in the absence of symptoms suggestive of urinary tract infection and of primary care practitioners to not treat ASB. In preintervention period, 23 of 38 (61%) antibiotic regimens prescribed for urinary tract indications were for ASB. In the 6 months after the intervention, inappropriate submission of urine cultures decreased from 2.6 to 0.9 per 1000 patient-days (P < .0001), overall rate of treatment of ASB was reduced from 1.7 to 0.6 per 1000 patient-days (P = .0017), and total antimicrobial days of therapy were reduced from 167.7 to 117.4 per 1000 patient-days (P < .001). These reductions were maintained for 30 months after beginning the intervention. Educational interventions requiring minimal resources can result in sustained reductions in inappropriate treatment of ASB in long-term care and decreased total antimicrobial use. Education of the nursing staff regarding appropriate criteria for requesting urine cultures should be a component of such interventions.