Asymptomatic bacteriuria in critical-access hospitals: Prevalence and patient characteristics driving treatment

Hartlage, Whitney; Bryson-Cahn, Chloe; Castillo, Alyssa Y.; Jain, Rupali; Lynch, John B.; Martinez-Paz, Natalia; Chan, Jeannie D.; Kassamali Escobar, Zahra

doi:10.1017/ice.2023.220

Infect. Control Hosp. Epidemiol.

2023

DOI: 10.1017/ice.2023.220

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Asymptomatic bacteriuria in critical-access hospitals: Prevalence and patient characteristics driving treatment

Whitney Hartlage,

Chloe Bryson-Cahn,

Alyssa Y. Castillo

et al.

Abstract: We evaluated the prevalence and treatment of asymptomatic bacteriuria (ASB) in 17 critical-access hospitals. Among 891 patients with urine cultures from September 2021 to June 2022, 170 (35%) had ASB. Also, 76% of patients with ASB received antibiotics for a median duration of 7 days, demonstrating opportunities for antimicrobial stewardship.

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2024

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Cited by 4 publications

References 11 publications

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Antimicrobial stewardship and quality improvement strategies in critical access hospitals: a process evaluation of an intensive quality improvement cohort

Kassamali-Escobar,

Hartlage,

Chan

et al. 2024

ASHE

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Antimicrobial stewardship and quality improvement strategies in critical access hospitals: a process evaluation of an intensive quality improvement cohort

Kassamali-Escobar,

Hartlage,

Chan

et al. 2024

ASHE

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Antimicrobial stewardship to reduce overtreatment of asymptomatic bacteriuria in critical access hospitals: measuring a quality improvement intervention

Ciarkowski,

Imlay,

Bryson-Cahn

et al. 2024

Infect. Control Hosp. Epidemiol.

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Background: Asymptomatic bacteriuria (ASB) treatment is a common form of antibiotic overuse and diagnostic error. Antibiotic stewardship using the inappropriate diagnosis of urinary tract infection (ID-UTI) measure has reduced ASB treatment in diverse hospitals. However, critical access hospitals (CAHs) have differing resources that could impede stewardship. We aimed to determine if stewardship including the ID-UTI measure could reduce ASB treatment in CAHs. Methods: From October 2022 to July 2023, ten CAHs participated in an Intensive Quality Improvement Cohort (IQIC) program including 3 interventions to reduce ASB treatment: 1) learning labs (ie, didactics with shared learning), 2) mentoring, and 3) data-driven performance reports including hospital peer comparison based on the ID-UTI measure. To assess effectiveness of the IQIC program, change in the ID-UTI measure (ie, percentage of patients treated for a UTI who had ASB) was compared to two non-equivalent control outcomes (antibiotic duration and unjustified fluoroquinolone use). Results: Ten CAHs abstracted a total of 608 positive urine culture cases. Over the cohort period, the percentage of patients treated for a UTI who had ASB declined (aOR per month = 0.935, 95% CI: 0.873, 1.001, P = 0.055) from 28.4% (range across hospitals, 0%-63%) in the first to 18.6% (range, 0%-33%) in the final month. In contrast, antibiotic duration and unjustified fluoroquinolone use were unchanged (P = 0.768 and 0.567, respectively). Conclusions: The IQIC intervention, including learning labs, mentoring, and performance reports using the ID-UTI measure, was associated with a non-significant decrease in treatment of ASB, while control outcomes (duration and unjustified fluoroquinolone use) did not change.

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A Critical Contrast: Washington State's Case for Critical Access Hospital Benchmarks

Zering,

Kamenar,

Okhagbuzo

et al. 2024

Open Forum Infectious Diseases

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Asymptomatic bacteriuria in critical-access hospitals: Prevalence and patient characteristics driving treatment

Cited by 4 publications

References 11 publications

Antimicrobial stewardship and quality improvement strategies in critical access hospitals: a process evaluation of an intensive quality improvement cohort

Antimicrobial stewardship and quality improvement strategies in critical access hospitals: a process evaluation of an intensive quality improvement cohort

Antimicrobial stewardship to reduce overtreatment of asymptomatic bacteriuria in critical access hospitals: measuring a quality improvement intervention

A Critical Contrast: Washington State's Case for Critical Access Hospital Benchmarks

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