Evaluation of an Antimicrobial Stewardship Approach to Minimize Overuse of Antibiotics in Patients with Asymptomatic Bacteriuria

Kelley, Denise; Aaronson, Patrick; Poon, E.; McCarter, Yvette S.; Bato, Ben; Jankowski, Christopher A.

doi:10.1086/674848

Cited by 37 publications

(40 citation statements)

References 7 publications

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“….0001). 1 We agree with the authors that treatment of ASB presents a significant problem. The Infectious Diseases Society of America (IDSA) guidelines regarding ASB recommend against treating adults with ASB except pregnant women and individuals undergoing urologic procedures.…”

Section: Antibiotic Burden Associated With Treatment Of Asymptomatic supporting

confidence: 85%

“…To the Editor-We read with interest the report by Kelley et al 1 entitled "Evaluation of an Antimicrobial Stewardship Approach to Minimize Overuse of Antibiotics in Patients with Asymptomatic Bacteriruira." These authors used an observational retrospective study design to evaluate the impact of an antimicrobial stewardship program (ASP) educational initiative on asymptomatic bacteriuria (ASB) management at their institution.…”

Section: Antibiotic Burden Associated With Treatment Of Asymptomatic mentioning

confidence: 99%

“…[5][6][7] The findings of these studies as well as our own findings and those of Kelley et al 1 demonstrate a 32%-65% treatment rate of ASB when ASP and ASB education are lacking, despite IDSA guideline recommendations. 1,2,[5][6][7] ASPs are critically important in combating the overuse and misuse of antibiotics. We commend Kelley et al 1 for the success of their ASP educational initiative at decreasing empirical antibiotic prescribing in ASB at their institution.…”

Section: Antibiotic Burden Associated With Treatment Of Asymptomatic mentioning

confidence: 99%

“…1,2,[5][6][7] ASPs are critically important in combating the overuse and misuse of antibiotics. We commend Kelley et al 1 for the success of their ASP educational initiative at decreasing empirical antibiotic prescribing in ASB at their institution. However, additional factors that may influence antibiotic prescribing in ASB, such as urinalysis result, quantity of bacteria isolated, and bacterial species isolated, were not reported for each group, potentially limiting their evaluation.…”

Section: Antibiotic Burden Associated With Treatment Of Asymptomatic mentioning

confidence: 99%

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Antibiotic Burden Associated with Treatment of Asymptomatic Bacteriuria

Elefritz

Deutscher

Stevenson

et al. 2014

Infect. Control Hosp. Epidemiol.

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Antibiotic Burden Associated with Treatment of Asymptomatic BacteriuriaTo the Editor-We read with interest the report by Kelley et al 1 entitled "Evaluation of an Antimicrobial Stewardship Approach to Minimize Overuse of Antibiotics in Patients with Asymptomatic Bacteriruira." These authors used an observational retrospective study design to evaluate the impact of an antimicrobial stewardship program (ASP) educational initiative on asymptomatic bacteriuria (ASB) management at their institution. Select components of the educational initiative included in-service presentations targeted at physicians and pharmacists, posting of notifications and memorandums, distribution of pocket cards, and daily review of antibiotics for the treatment of urinary tract infections (UTIs) by ASP members. They found a decrease in empirical antibiotic administration from 66 (62%) of 107 patients before the initiative to 28 (26%) of 107 patients after the initiative (P ! .0001). 1We agree with the authors that treatment of ASB presents a significant problem. The Infectious Diseases Society of America (IDSA) guidelines regarding ASB recommend against treating adults with ASB except pregnant women and individuals undergoing urologic procedures.2 Administration of antibiotics when not indicated may result in adverse drug reactions, development of antibiotic resistance, and Clostridium difficile infection.3,4 Therefore, we have also taken steps to evaluate the management of ASB at our institution and estimate the added antibiotic burden resulting from the treatment of ASB, focusing on patients with an indwelling urinary catheter. We outline the results of our evaluation here. A comparative observational study of catheterized patients with ASB was conducted. Retrospective medical record review was completed for patients who met the following inclusion criteria: (1) age 18-89 years; (2) admission to an internal medicine or surgery service between November 1, 2011, and November 31, 2012; (3) a urine culture containing 10 4 colony-forming units/mL bacteria or greater; and (4) a urinary catheter in place for 24 hours or more before the culture was obtained. Patients were excluded on the basis of documentation of 1 or more of the following symptoms of a UTI: temperature 37.9ЊC or more, costovertebral tenderness, dysuria, urinary frequency, urinary urgency, rigors, new onset delirium, and increased muscle spasticity in quadriplegic and paraplegic patients. Additional exclusion criteria similar to those used by Kelley et al 1 included pregnancy; medical history of a solid organ transplant; known urinary tract anatomical abnormality; renal stones; malignancy; foreign bodies of the urinary tract; being scheduled for genitourinary manipulation within 24 hours of culture; candiduria; death or hospital discharge before culture results were available; or current incarceration. Patients were considered to be treated for ASB if an antibiotic targeted at the bacteria isolated from the urine was administered within 5 days of culture obtainment. If a patient...

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Section: Antibiotic Burden Associated With Treatment Of Asymptomatic supporting

confidence: 85%

Section: Antibiotic Burden Associated With Treatment Of Asymptomatic mentioning

confidence: 99%

Section: Antibiotic Burden Associated With Treatment Of Asymptomatic mentioning

confidence: 99%

Section: Antibiotic Burden Associated With Treatment Of Asymptomatic mentioning

confidence: 99%

See 2 more Smart Citations

Antibiotic Burden Associated with Treatment of Asymptomatic Bacteriuria

Elefritz

Deutscher

Stevenson

et al. 2014

Infect. Control Hosp. Epidemiol.

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“…2,3 Despite these available clear guidelines from the IDSA, clinicians continue to misdiagnose and inappropriately manage ASB. [5][6][7][8][9][10] This article reviews the following:…”

Section: Key Pointsmentioning

confidence: 99%

Asymptomatic Bacteriuria in Noncatheterized Adults

Ferroni

Taylor

2015

Urologic Clinics of North America

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Effectiveness of an Antimicrobial Stewardship Approach for Urinary Catheter–Associated Asymptomatic Bacteriuria

et al. 2015

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IMPORTANCE Overtreatment of asymptomatic bacteriuria (ASB) in patients with urinary catheters remains high. Health care professionals have difficulty differentiating cases of ASB from catheter-associated urinary tract infections.OBJECTIVES To evaluate the effectiveness and sustainability of an intervention to reduce urine culture ordering and antimicrobial prescribing for catheter-associated ASB compared with standard quality improvement methods. DESIGN, SETTING, AND PARTICIPANTSA preintervention and postintervention comparison with a contemporaneous control group from July 2010 to June 2013 at 2 Veterans Affairs health care systems. Study populations were patients with urinary catheters on acute medicine wards and long-term care units and health care professionals who order urine cultures and prescribe antimicrobials.INTERVENTION A multifaceted guidelines implementation intervention. MAIN OUTCOMES AND MEASURESThe primary outcomes were urine cultures ordered per 1000 bed-days and cases of ASB receiving antibiotics (overtreatment) during intervention and maintenance periods compared with baseline at both sites. Patient-level analysis of inappropriate antimicrobial use adjusted for individual covariates.RESULTS Study surveillance included 289 754 total bed-days. The overall rate of urine culture ordering decreased significantly during the intervention period (from 41.2 to 23.3 per 1000 bed-days; incidence rate ration [IRR], 0.57; 95% CI, 0.53-0.61) and further during the maintenance period (to 12.0 per 1000 bed-days; IRR, 0.29; 95% CI, 0.26-0.32) (P < .001 for both). At the comparison site, urine cultures ordered did not change significantly across all 3 periods. There was a significant difference in the number of urine cultures ordered per month over time when comparing the 2 sites using longitudinal linear regression (P < .001). Overtreatment of ASB at the intervention site fell significantly during the intervention period (from 1.6 to 0.6 per 1000 bed-days; IRR, 0.35; 95% CI, 0.22-0.55), and these reductions persisted during the maintenance period (to 0.4 per 1000 bed-days; IRR, 0.24; 95% CI, 0.13-0.42) (P < .001 for both). Overtreatment of ASB at the comparison site was similar across all periods (odds ratio, 1.32; 95% CI, 0.69-2.52). When analyzed by type of ward, the decrease in ASB overtreatment was significant in long-term care. CONCLUSIONS AND RELEVANCEA multifaceted intervention targeting health care professionals who diagnose and treat patients with urinary catheters reduced overtreatment of ASB compared with standard quality improvement methods. These improvements persisted during a low-intensity maintenance period. The impact was more pronounced in long-term care, an emerging domain for antimicrobial stewardship.

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Evaluation of an Antimicrobial Stewardship Approach to Minimize Overuse of Antibiotics in Patients with Asymptomatic Bacteriuria

Cited by 37 publications

References 7 publications

Antibiotic Burden Associated with Treatment of Asymptomatic Bacteriuria

Antibiotic Burden Associated with Treatment of Asymptomatic Bacteriuria

Asymptomatic Bacteriuria in Noncatheterized Adults

Effectiveness of an Antimicrobial Stewardship Approach for Urinary Catheter–Associated Asymptomatic Bacteriuria

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