Increasing Evidence That Diagnostic Stewardship May Improve Antibiotic Use

Morgan, Daniel J; Leekha, Surbhi; Claeys, Kimberly C

doi:10.1001/jamainternmed.2023.2756

Cited by 3 publications

(2 citation statements)

References 9 publications

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“… 1 Asymptomatic bacteriuria is often misdiagnosed by clinicians and patients as a UTI following over-interpretation of positive urine cultures. 2 This is common among older adults 3 , 4 who are at the highest risk for significant side effects from unnecessary antibiotics. 5 , 6 Inappropriate antibiotic use for ASB leads to adverse events 7 and contributes to global antibiotic resistance.…”

Section: Introductionmentioning

confidence: 99%

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Older adults’ and caregivers’ perceptions about urinary tract infection and asymptomatic bacteriuria guidelines: a qualitative exploration

Durkin,

Schmitz,

Hsueh

et al. 2023

ASHE

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Objective: To explore older adults’ and caregivers’ knowledge and perceptions of guidelines for appropriate antibiotics use for bacteria in the urine. Design: Semi-structured qualitative interviews. Setting: Infectious disease clinics, community senior living facilities, memory care clinics, and general public. Participants: Patients 65 years or older diagnosed with a urinary tract infection (UTI) in the past two years, or caregivers of such patients. Methods: We conducted interviews between March and July 2023. We developed an interview guide based on the COM-B (capability, opportunity, motivation-behavior) behavior change framework. We thematically analyzed written transcripts of audio-recorded interviews using inductive and deductive coding techniques. Results: Thirty participants (21 patients, 9 caregivers) enrolled. Most participants understood UTI symptoms such as pain during urination and frequent urination. However, communication with multiple clinicians, misinformation, and unclear symptoms that overlapped with other health issues clouded their understanding of asymptomatic bacteriuria (ASB) and UTIs. Some participants worried that clinicians would be dismissive of symptoms if they suggested a diagnosis of ASB without prescribing antibiotics. Many participants felt that the benefits of taking antibiotics for ASB outweighed harms, though some mentioned fears of personal antibiotic resistance if taking unnecessary antibiotics. No participants mentioned the public health impact of potential antibiotic resistance. Most participants trusted information from clinicians over brochures or websites but wanted to review information after clinical conversations. Conclusion: Clinician-focused interventions to reduce antibiotic use for ASB should also address patient concerns during clinical visits, and provide standardized high-quality educational materials at the end of the visit.

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Section: Introductionmentioning

confidence: 99%

“…5,6 Inappropriate antibiotic use for ASB leads to adverse events 7 and contributes to global antibiotic resistance. 2,8 Experts estimate that 10 million people could die annually due to antibiotic resistance globally by 2050. 9 Clinical decision support can reduce overuse of antibiotics for ASB.…”

Section: Introductionmentioning

confidence: 99%

Older adults’ and caregivers’ perceptions about urinary tract infection and asymptomatic bacteriuria guidelines: a qualitative exploration

Durkin,

Schmitz,

Hsueh

et al. 2023

ASHE

View full text Add to dashboard Cite

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Diagnostic Stewardship for Urine Cultures

Coffey,

Claeys,

Morgan

2024

Infectious Disease Clinics of North America

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Eliciting Clinician Perspectives on Asymptomatic Bacteriuria to Identify Targets for Antimicrobial Stewardship Education and Decision Support

Durkin,

Schmitz,

Hsueh

et al. 2024

Open Forum Infectious Diseases

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Objective To elicit clinicians’ perspectives to help reduce antibiotic prescribing for asymptomatic bacteriuria and improve a patient-centered educational brochure for older adults with urinary tract infections or asymptomatic bacteriuria. Design Semi-structured qualitative interviews. Setting Infectious disease clinics, community senior living facilities, memory care clinics, and general practice Participants Clinicians who treat patients 65 years or older for urinary tract infections or bacteria in the urine Methods We conducted semi-structured qualitative interviews between October 2023 and April 2024. We developed an interview guide based on a behavior change framework. We thematically analyzed written transcripts of audio-recorded interviews using inductive and deductive coding techniques. Results We identified several common themes surrounding management of asymptomatic bacteriuria from clinicians. These included an emphasis on ordering and interpreting urine tests, tension between guidelines and individual patient care for older adults, use of epidemiologic data to influence prescribing practices, pre-prepared communication talking points, and interest in educational materials for patients and clinical teams. Conclusion Education about the need for symptoms to supplement urine testing, data about the impact of overuse of antibiotics, and oral and written communication strategies should be addressed to reduce antibiotic prescribing for asymptomatic bacteriuria.

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Increasing Evidence That Diagnostic Stewardship May Improve Antibiotic Use

Cited by 3 publications

References 9 publications

Older adults’ and caregivers’ perceptions about urinary tract infection and asymptomatic bacteriuria guidelines: a qualitative exploration

Older adults’ and caregivers’ perceptions about urinary tract infection and asymptomatic bacteriuria guidelines: a qualitative exploration

Diagnostic Stewardship for Urine Cultures

Eliciting Clinician Perspectives on Asymptomatic Bacteriuria to Identify Targets for Antimicrobial Stewardship Education and Decision Support

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