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Modified reporting of positive urine cultures to reduce inappropriate antibiotic treatment of catheter-associated asymptomatic bacteriuria (CA-ASB) among inpatients, a randomized controlled trial

Published online by Cambridge University Press:  04 June 2021

Claire L. Pratt ,
Zahra Rehan ,
Lydia Xing ,
Laura Gilbert ,
Brenda Fillier ,
Brendan Barrett  and
Peter Daley Open the ORCID record for Peter Daley [Opens in a new window]
Claire L. Pratt
Affiliation:
Memorial University of Newfoundland Department of Clinical Epidemiology, St John’s, Newfoundland and Labrador, Canada
Zahra Rehan
Affiliation:
Memorial University of Newfoundland Department of Clinical Epidemiology, St John’s, Newfoundland and Labrador, Canada
Lydia Xing
Affiliation:
Memorial University of Newfoundland Department of Clinical Epidemiology, St John’s, Newfoundland and Labrador, Canada Memorial University of Newfoundland, Faculty of Medicine, St John’s, Newfoundland and Labrador, Canada
Laura Gilbert
Affiliation:
Memorial University of Newfoundland, Faculty of Medicine, St John’s, Newfoundland and Labrador, Canada Eastern Health, St John’s, Newfoundland and Labrador, Canada
Brenda Fillier
Affiliation:
Eastern Health, St John’s, Newfoundland and Labrador, Canada
Brendan Barrett
Affiliation:
Memorial University of Newfoundland Department of Clinical Epidemiology, St John’s, Newfoundland and Labrador, Canada Memorial University of Newfoundland, Faculty of Medicine, St John’s, Newfoundland and Labrador, Canada Eastern Health, St John’s, Newfoundland and Labrador, Canada
Peter Daley*
Affiliation:
Memorial University of Newfoundland Department of Clinical Epidemiology, St John’s, Newfoundland and Labrador, Canada Memorial University of Newfoundland, Faculty of Medicine, St John’s, Newfoundland and Labrador, Canada Eastern Health, St John’s, Newfoundland and Labrador, Canada
*
Author for correspondence: Peter Daley E-mail: pkd336@mun.ca
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Abstract

Objective:

To determine whether modified reporting of positive urine cultures collected from indwelling catheters improved treatment decisions without causing harm.

Design:

Prospective, unblinded, randomized control trial.

Setting:

Two tertiary-care hospitals.

Participants:

Overall, 100 consecutive positive urine cultures collected from catheterized inpatients were randomized between standard and modified laboratory reporting between November 2018 and June 2019. Exclusion criteria were pregnancy, current antibiotic treatment, ICU or urology admission, or neutropenia.

Intervention:

The modified report included significant growth without providing identification, quantification, or susceptibility. The standard report included identification, quantitation and susceptibility. Diagnosis of catheter-associated asymptomatic bacteriuria (CA-ASB) and catheter-associated urinary tract infection (CA-UTI) followed published criteria, using prospective chart review. The appropriate antibiotic treatment was defined as treatment of CA-UTI, and no treatment of CA-ASB. Patients were followed for 7 days.

Results:

Of 543 urine cultures, 443 (82%) were excluded. Of 100 patients, 75 (75%) had CA-ASB and 25 (25%) had CA-UTI. Treatment was given to 45 of 75 CA-ASB patients (60%) and all 25 CA-UTI patients (100%). Appropriate treatment rate was higher in the modified reporting arm than in the standard reporting arm: 57% vs 50% (+7.4%; relative risk [RR], 1.15; P = .45). Untreated CA-ASB was higher in the modified reporting arm: 45% vs 33% (+12%; RR, 1.36; P = .30). The standard report was requested for 33% of modified reports. Furthermore, 4 deaths and 26.9% adverse events occurred in the modified reporting arm, and 3 deaths and 41.3% adverse events occurred in the standard reporting arm.

Conclusions:

Modified reporting increased the appropriateness of treatment, and may be safe.

Clinical trials identifier: ClinicalTrials.gov#NCT03488355.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 10 , October 2021 , pp. 1221 - 1227
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Nicolle, LE, Gupta, K, Bradley, SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis 2019;68:E83–E75.CrossRefGoogle ScholarPubMed
Daley, P, Garcia, D, Inayatullah, R, Penney, C, Boyd, S. Modified reporting of positive urine cultures to reduce inappropriate treatment of asymptomatic bacteriuria among nonpregnant, noncatheterized inpatients: a randomized controlled trial. Infect Control Hosp Epidemiol 2018;39:814–819.CrossRefGoogle ScholarPubMed
Givler, A, Givler, DN. Asymptomatic bacteriuria. StatPearls Publ LLC 2019. https://www.ncbi.nlm.nih.gov/books/NBK441848/. Accessed July 24, 2019.Google Scholar
Nicolle, LE, Bradley, S, Colgan, R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643–654.CrossRefGoogle Scholar
Leis, JA, Rebick, GW, Daneman, N, et al. Reducing antimicrobial therapy for asymptomatic bacteriuria among noncatheterized inpatients: a proof-of-concept study. Clin Infect Dis 2014;58:980–983.CrossRefGoogle ScholarPubMed
Claeys, KC, Blanco, N, Morgan, DJ, Leekha, S, Sullivan, KV. Advances and challenges in the diagnosis and treatment of urinary tract infections: the need for diagnostic stewardship. Curr Infect Dis Rept 2019;21:2.Google ScholarPubMed
Lo, E, Nicolle, LE, Coffin, SE, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:464–479.CrossRefGoogle ScholarPubMed
Focus on Geography Series, 2016 Census. Statitistics Canada website. https://www12.statcan.gc.ca/census-recensement/2016/as-sa/fogs-spg/Index-eng.cfmPublished 2017. Accessed January 5, 2021.Google Scholar
Boka, K. Systemic inflammatory response syndrome (SIRS) clinical presentation. Medscape 2018:20.Google Scholar
Jaeger, C, Waymack, J, Sullivan, P, et al. Refining reflex urine culture testing in the ED. Am J Emerg Med 2019;37:1380–1382.Google ScholarPubMed
Redwood, R, Knobloch, MJ, Pellegrini, DC, Ziegler, MJ, Pulia, M, Safdar, N. Reducing unnecessary culturing: a systems approach to evaluating urine culture ordering and collection practices among nurses in two acute-care settings. Antimicrob Resist Infect Control 2018;7:4.CrossRefGoogle ScholarPubMed
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
Hooton, TM, Gupta, K. Acute complicated urinary tract infection (including pyelonephritis) in adults. UpToDate wesbite. https://www.uptodate.com/contents/acute-complicated-urinary-tract-infection-including-pyelonephritis-in-adults. Published 2019. Accessed December 29, 2019.Google Scholar
Langford, BJ, Leung, E, Haj, R, et al. Nudging In MicroBiology Laboratory Evaluation (NIMBLE): a scoping review. Infect Control Hosp Epidemiol 2019;40:1–7.CrossRefGoogle Scholar
Maclaggan, TDM, Le, CP, Iverson, KA, et al. The clinical impact of a urinary tract infection management bundle in a tertiary-care teaching hospital. Infect Control Hosp Epidemiol 2018;40:72–78.CrossRefGoogle Scholar