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Evaluating a Hospitalist-Based Intervention to Decrease Unnecessary Antimicrobial Use in Patients With Asymptomatic Bacteriuria

Published online by Cambridge University Press:  06 June 2016

Sarah E. Hartley ,
Latoya Kuhn ,
Staci Valley ,
Laraine L. Washer ,
Tejal Gandhi ,
Jennifer Meddings ,
Michelle Robida ,
Salas Sabnis ,
Carol Chenoweth  and
Anurag N. Malani
...Show all authors
Sarah E. Hartley
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan Veterans’ Administration Ann Arbor Healthcare System, Ann Arbor, Michigan
Latoya Kuhn
Affiliation:
Veterans’ Administration Ann Arbor Healthcare System, Ann Arbor, Michigan Veterans’ Affairs/University of Michigan Patient Safety Enhancement Program (PSEP), Ann Arbor, Michigan
Staci Valley
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Laraine L. Washer
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan Department of Infection Prevention and Epidemiology, University of Michigan, Ann Arbor, Michigan
Tejal Gandhi
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Jennifer Meddings
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan Veterans’ Affairs/University of Michigan Patient Safety Enhancement Program (PSEP), Ann Arbor, Michigan
Michelle Robida
Affiliation:
St. Joseph Mercy Hospital, Ann Arbor, Michigan
Salas Sabnis
Affiliation:
St. Joseph Mercy Hospital, Ann Arbor, Michigan
Carol Chenoweth
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Anurag N. Malani
Affiliation:
St. Joseph Mercy Hospital, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan Veterans’ Administration Ann Arbor Healthcare System, Ann Arbor, Michigan Veterans’ Affairs/University of Michigan Patient Safety Enhancement Program (PSEP), Ann Arbor, Michigan
Scott A. Flanders
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Abstract

OBJECTIVE

Inappropriate treatment of asymptomatic bacteriuria (ASB) in the hospital setting is common. We sought to evaluate the treatment rate of ASB at the 3 hospitals and assess the impact of a hospitalist-focused improvement intervention.

DESIGN

Prospective, interventional trial.

SETTING

Two community hospitals and a tertiary-care academic center.

PATIENTS

Adult patients with a positive urine culture admitted to hospitalist services were included in this study. Exclusions included pregnancy, intensive care unit admission, history of a major urinary procedure, and actively being treated for a urinary tract infection (UTI) at the time of admission or >48 hours prior to urine collection.

INTERVENTIONS

An educational intervention using a pocket card was implemented at all sites followed by a pharmacist-based intervention at the academic center. Medical records of the first 50 eligible patients at each site were reviewed at baseline and after each intervention for signs and symptoms of UTI, microbiological results, antimicrobials used, and duration of treatment for positive urine cultures. Diagnosis of ASB was determined through adjudication by 2 hospitalists and 2 infectious diseases physicians.

RESULTS

Treatment rates of ASB decreased (23.5%; P=.001) after the educational intervention. Reductions in treatment rates for ASB differed by site and were greatest in patients without classic signs and symptoms of UTI (34.1%; P<.001) or urinary catheters (31.2%; P<.001). The pharmacist-based intervention was most effective at reducing ASB treatment rates in catheterized patients.

CONCLUSIONS

A hospitalist-focused educational intervention significantly reduced ASB treatment rates. The impact varied across sites and by patient characteristics, suggesting that a tailored approach may be useful.

Infect Control Hosp Epidemiol 2016;37:1044–1051

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 9 , September 2016 , pp. 1044 - 1051
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. Preliminary data were reported as an abstract at the Society of Hospital Medicine Annual Meeting in Las Vegas, Nevada, on March 25, 2014.

References

REFERENCES

1. Cope, M, Cevallos, ME, Cadle, RM, Darouiche, RO, Musher, DM, Trautner, BW. Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital. Clin Infect Dis 2009;48:1182–1188.Google Scholar
2. Pavese, P, Saurel, N, Labarere, J, et al. Does an educational session with an infectious diseases physician reduce the use of inappropriate antibiotic therapy for inpatients with positive urine culture results? A controlled before-and-after study. Infect Control Hosp Epidemiol 2009;30:596–599.CrossRefGoogle ScholarPubMed
3. Kelley, D, Aaronson, P, Poon, E, McCarter, YS, Bato, B, Jankowski, CA. Evaluation of an antimicrobial stewardship approach to minimize overuse of antibiotics in patients with asymptomatic bacteriuria. Infect Control Hosp Epidemiol 2014;35:193–195.CrossRefGoogle ScholarPubMed
4. Nicolle, LE, Bradley, S, Colgan, R, Rice, JC, Schaeffer, A, Hooton, TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643–654.Google Scholar
5. Trautner, BW, Petersen, NJ, Hysong, SJ, Horwitz, D, Kelly, PA, Naik, AD. Overtreatment of asymptomatic bacteriuria: identifying provider barriers to evidence-based care. Am J Infect Control 2014;42:653–658.Google Scholar
6. Chowdhury, F, Sarkar, K, Branche, A, et al. Preventing the inappropriate treatment of asymptomatic bacteriuria at a community teaching hospital. J Community Hosp Intern Med Perspect 2012;2(2). doi: 10.3402/jchimp.v2i2.17814.Google Scholar
7. Bonnal, C, Baune, B, Mion, M, et al. Bacteriuria in a geriatric hospital: impact of an antibiotic improvement program. J Am Med Dir Assoc 2008;9:605–609.CrossRefGoogle Scholar
8. Leis, JA, Palmay, L, Elligsen, M, Walker, SA, Lee, C, Daneman, N. Lessons from audit and feedback of hospitalized patients with bacteriuria. Am J Infect Control 2014;42:1136–1137.Google Scholar
9. Linares, LA, Thornton, DJ, Strymish, J, Baker, E, Gupta, K. Electronic memorandum decreases unnecessary antimicrobial use for asymptomatic bacteriuria and culture-negative pyuria. Infect Control Hosp Epidemiol 2011;32:644–648.CrossRefGoogle ScholarPubMed
10. Trautner, BW, Grigoryan, L, Petersen, NJ, et al. Effectiveness of an antimicrobial stewardship approach for urinary catheter-associated asymptomatic bacteriuria. JAMA Intern Med 2015;175:1120–1127.CrossRefGoogle ScholarPubMed
11. Centers for Disease Control and Prevention (CDC) Division of Healthcare Quality Promotion. Catheter-associated urinary tract infection (CAUTI) event. In: The National Healthcare Safety Network (NHSN) Manual. Atlanta, GA: CDC, 2009. Available at: http://www.cdc.gov/nhsn/PDFs/pscManual/pscManual_current.pdf.Google Scholar
12. The prevention and management of urinary tract infections among people with spinal cord injuries. National Institute on Disability and Rehabilitation Research Consensus Statement. J Am Paraplegia Soc 1992;15:194–204.CrossRefGoogle Scholar
13. Gupta, K, Hooton, TM, Naber, KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:e103–e120.Google Scholar
14. Hooton, TM, Bradley, SF, Cardenas, DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010;50:625–663.CrossRefGoogle ScholarPubMed
15. Inouye, SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med 1994;97:278–288.Google Scholar
16. Loeb, M, Bentley, DW, Bradley, S, et al. Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference. Infect Control Hosp Epidemiol 2001;22:120–124.Google Scholar
17. Ogrinc, G, Davies, L, Goodman, D, Batalden, P, Davidoff, F, Stevens, D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf 2015:1–7.Google Scholar
18. Charani, E, Castro-Sanchez, E, Sevdalis, N, et al. Understanding the determinants of antimicrobial prescribing within hospitals: the role of “prescribing etiquette”. Clin Infect Dis 2013;57:188–196.Google Scholar