Antibiotic Prescribing Practices for Catheter Urine Culture Results

Chiu, Jonathan; Thompson, G William; Austin, Thomas W.; Hussain, Zafar; John, Michael; Bombassaro, Anne Marie; Connelly, Sarah E.; Elsayed, Sameer

doi:10.4212/cjhp.v66i1.1207

Cited by 5 publications

(7 citation statements)

References 23 publications

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“…The 30 studies included in our analysis reported on a total of 4129 ASB cases ( Table 1 ) [ 1 , 4 , 12–14 , 21–45 ]. The majority of studies were performed in North America (16 in the United States [ 1 , 4 , 14 , 21 , 26–28 , 30–32 , 36–38 , 41 , 43 , 44 ] and 7 in Canada [ 13 , 24 , 25 , 33 , 34 , 40 , 42 ]) and Europe (3 in France [ 35 , 39 , 45 ], 1 in Italy [ 23 ], and 1 in Spain [ 29 ]). Finally, 1 study each was performed in New Zealand [ 22 ] and South Korea [ 12 ].…”

Section: Resultsmentioning

confidence: 99%

“…No small study effect across the included studies was detected (ΕΤ, 1.01; P ET , 0.161). Twenty-two out of the 30 studies were performed in inpatient populations and had a rate of inappropriate treatment of 45% (95% CI, 38–51) [ 1 , 12–14 , 21 , 22 , 24–28 , 31 , 33–36 , 39–42 , 44 , 45 ]. Two were performed in outpatient settings [ 23 , 29 ], 1 in the emergency department [ 32 ], 1 among nursing home residents [ 43 ], and 4 in a mixture of settings [ 4 , 30 , 37 , 38 ].…”

Section: Resultsmentioning

confidence: 99%

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Inappropriate Management of Asymptomatic Patients With Positive Urine Cultures: A Systematic Review and Meta-analysis

Flokas

Andreatos

Alevizakos

et al. 2017

Open Forum Infectious Diseases

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BackgroundMismanagement of asymptomatic patients with positive urine cultures (referred to as asymptomatic bacteriuria [ASB] in the literature) promotes antimicrobial resistance and results in unnecessary antimicrobial-related adverse events and increased health care costs.MethodsWe conducted a systematic review and meta-analysis of studies that reported on the rate of inappropriate ASB treatment published from 2004 to August 2016. The appropriateness of antimicrobial administration was based on guidelines published by the Infectious Diseases Society of America.ResultsA total of 2142 nonduplicate articles were identified, and among them 30 fulfilled our inclusion criteria. The pooled prevalence of antimicrobial treatment among 4129 cases who did not require treatment was 45% (95% CI, 39–50). Isolation of gram-negative pathogens (odds ratio [OR], 3.58; 95% CI, 2.12–6.06), pyuria (OR, 2.83; 95% CI, 1.9–4.22), nitrite positivity (OR, 3.83; 95% CI, 2.24–6.54), and female sex (OR, 2.11; 95% CI, 1.46–3.06) increased the odds of receiving treatment. The rates of treatment were higher in studies with ≥100 000 cfu/mL cutoff values compared with <10 000 cfu/mL for bacterial growth (P, .011). The implementation of educational and organizational interventions designed to eliminate the overtreatment of ASB resulted in a median absolute risk reduction of 33% (rangeARR, 16–36%, medianRRR, 53%; rangeRRR, 25–80%).ConclusionThe mismanagement of ASB remains extremely frequent. Female sex and the overinterpretation of certain laboratory data (positive nitrites, pyuria, isolation of gram-negative bacteria and cultures with higher microbial count) are associated with overtreatment. Even simple stewardship interventions can be particularly effective, and antimicrobial stewardship programs should focus on the challenge of differentiating true urinary tract infection from ASB.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Inappropriate Management of Asymptomatic Patients With Positive Urine Cultures: A Systematic Review and Meta-analysis

Flokas

Andreatos

Alevizakos

et al. 2017

Open Forum Infectious Diseases

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“…Unfortunately, awareness that overtreatment of ASB is a problem has preceded any immediate widespread solutions; currently many of the episodes diagnosed and treated as CAUTI in the hospital are really ASB. 20,44,87 In the future, perhaps some of the resources that have been channeled into reducing CAUTI and other healthcare-associated infections 88 can be used to support effective ASB guidelines implementation programs.…”

Section: Discussionmentioning

confidence: 99%

“…In one study in catheterized inpatients, 201 (69%) of 293 days of antibiotic therapy to treat the urine were unnecessary. 44 A three-year retrospective study of patients with vancomycin-resistant enterococci in their urine documented that over 200 days of antimicrobial therapy were not indicated, resulting in $50,000 in unnecessary antimicrobial costs. 45 …”

Section: Epidemiology and Significance Of Asbmentioning

confidence: 99%

Approach to a Positive Urine Culture in a Patient Without Urinary Symptoms

Trautner

Grigoryan

2014

Infectious Disease Clinics of North America

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Asymptomatic bacteriuria (ASB) is a condition in which bacteria are present in a noncontaminated urine sample collected from a patient without signs or symptoms related to the urinary tract. ASB must be distinguished from symptomatic UTI by the absence of signs and symptoms compatible with UTI or by clinical determination that a nonurinary etiology accounts for the patient's symptoms. ABU is a very common condition that is often treated unnecessarily with antibiotics. Pregnant women and persons undergoing urologic procedures expected to cause mucosal bleeding are the only two groups with convincing evidence that screening for and treating ASB is beneficial. Randomized, controlled trials of ASB screening and/or treatment have established the lack of efficacy in premenopausal adult women, diabetic women, patients with spinal cord injury, catheterized patients, older adults living in the community, and elderly institutionalized adults. The overall purpose of this review is to promote an awareness of ASB as a distinct condition from UTI and to empower clinicians to withhold antibiotics in situations in which antimicrobial treatment of bacteriuria is not indicated.

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“…Although microbiological studies form the basis of effective treatment, clinicians and hospital services show varying degree of interest in microbiological analysis to decide appropriate treatment. 6,7 There is increased case of Klebsiella infection and due to that there may be increased incidence of antibiotic resistance. Klebsiella causes various types of infection like: urinary tract infections, nosocomial infections, wound infections, community acquired pneumonia and chronic genital ulcerative disease etc.…”

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confidence: 99%

Antibiotic sensitivity profile of Klebsiella isolates and it’s impact on clinical outcome

Damor

Kubavat

2019

Int J Basic Clin Pharmacol

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Background: Antimicrobials are the greatest discovery of the twentieth century. To limit the emergence and spread of resistance, antibiotic therapy should be adjusted according to the results of microbiological culture. Klebsiella isolates causes various types of infections and the incidence of antibiotic resistance is also high in Klebsiella infections. So, Authors plan this study to analyze how the results of microbiological cultures influence the antibiotic use in the treatment of Klebsiella infections.Methods: It is a record based observational prospective study which assessed the impact of Klebsiella positive culture results on antibiotic prescribing pattern and its impact on clinical outcome. Patients with empirical antibiotic therapy and Klebsiella positive were included and patients with inadequate data were excluded in this study and the data were recorded. Recorded data were entered and analyzed in Microsoft Office Excel-2013. Unpaired student t-test was used to compare the mean duration of hospital stay using Past software (version 3.20).Results: There were total 400 patients in our study. Amikacin was the most common drug (n=202) used as empirical therapy. Empirical antibiotic therapy was changed in 161(40.25%) patients. Meropenem was the most commonly used definitive drug. Mean duration of hospital stay is less in empirical sensitive antibiotic therapy as compared to empirical resistance antibiotic therapy having p value <0.0001 which shows significant difference between two groups showing better clinical outcome.Conclusion: Initial empirical therapy with broad-spectrum antimicrobials is a treatment strategy for severe Klebsiella infections.

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Antibiotic Prescribing Practices for Catheter Urine Culture Results

Abstract: Background:The literature suggests that positive results of catheter urine cultures frequently lead to unnecessary antimicrobial prescribing, which therefore represents an important target for stewardship.

Cited by 5 publications

References 23 publications

Inappropriate Management of Asymptomatic Patients With Positive Urine Cultures: A Systematic Review and Meta-analysis

Inappropriate Management of Asymptomatic Patients With Positive Urine Cultures: A Systematic Review and Meta-analysis

Approach to a Positive Urine Culture in a Patient Without Urinary Symptoms

Antibiotic sensitivity profile of Klebsiella isolates and it’s impact on clinical outcome

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