230.   Preventing the Inappropriate Treatment of Asymptomatic Bacteriuria at Lutheran Medical Center: A Prospective Cohort Study
Session: Poster Abstract Session: Antimicrobial Stewardship in Clinical Practice
Friday, October 21, 2011
Room: Poster Hall B1
Background: 

The Infectious Diseases Society of America (IDSA) guidelines specify the indications for screening and treatment for asymptomatic bacteriuria. A hospital-wide educational intervention, based on these guidelines, addressed inappropriate treatment of asymptomatic bacteriuria in an urban community teaching hospital. The goal of this study was to assess that intervention’s effectiveness in preventing staff from inappropriately treating asymptomatic bacteriuria.

Methods: 

A retrospective chart review in February 2010 established both prevalence and cost for inappropriate treatment of asymptomatic bacteriuria. In January 2011, a hospital-wide intervention was conducted that included an educational seminar and handouts for the Internal Medicine, Surgery, and Family Medicine departments. Post-intervention data was collected prospectively from February 14 – March 15, 2011. Charts of patients with a positive urine culture, defined by bacterial counts > 105 CFU/mL, were reviewed for documentation of symptoms such as fever, urgency, frequency, dysuria, suprapubic tenderness, and change in mental status. The total costs for inappropriately treating asymptomatic bacteriuria were determined and compared to the pre-intervention costs.

Results: 

In the pre-intervention study, 64 (83%) of 109 patients were asymptomatic and 30 (47%) of them were treated. In the post-intervention phase, 13 (17%) of 55 patients were asymptomatic and 2 (15%) were treated, showing a significant decrease in inappropriately treated patients (p = 0.04).  Fewer urine cultures were collected during the post-intervention period than the pre-intervention period (3127 and 3419, respectively) (p < 0.001).  The total cost of inappropriately treating asymptomatic bacteriuria in the pre-intervention group was $1,213 compared to $617 in the post-intervention group.

Conclusion: 

The results demonstrated a significant decrease in the inappropriate treatment of asymptomatic bacteriuria.  The significantly greater number of asymptomatic patients in the pre-intervention group compared to the post-intervention group statistically suggests that the educational interventions also decreased inappropriate screening of asymptomatic patients.


Subject Category: J. Clinical practice issues

Farhana Chowdhury, MD1, Angela Branche, MD1, Aswini Mandhini, M.D.2, Angelica Nangit, BS1, Philip Dwek1, Kumkum Sarkar1, Kell Julliard, MA2, Julie Pearson, M.P.H.3, Soojin Sung, PharmD4, Juliette Kim, PharmD4, David Tompkins, MD1 and Ernest Visconti, MD1, (1)Internal Medicine, Lutheran Medical Center, Brooklyn, NY, (2)Lutheran Medical Center, Brooklyn, NY, (3)Clinical Research, Lutheran Medical Center, Brooklyn, NY, (4)Pharmacy, Lutheran Medical Center, Brooklyn, NY

Disclosures:

F. Chowdhury, None

A. Branche, None

A. Mandhini, None

A. Nangit, None

P. Dwek, None

K. Sarkar, None

K. Julliard, None

J. Pearson, None

S. Sung, None

J. Kim, None

D. Tompkins, None

E. Visconti, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.