204. Implementation of Asymptomatic Bacteriuria Guidelines Reduces Inappropriate Screening and Treatment
Session: Poster Abstract Session: Catheter-associated UTIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • ABU_project_outcomes_IDSA_2013 (Final).png (603.5 kB)
  • Background:

    Patients with urinary catheters should not undergo screening for or treatment of asymptomatic bacteriuria (ASB).  Health care providers have difficulty applying these guidelines to their own patients, and ASB is often erroneously managed as catheter-associated urinary tract infection (CAUTI).  We developed the “Kicking CAUTI Campaign: No Knee-Jerk Antibiotics” to improve antimicrobial stewardship for ASB.


    The Kicking CAUTI intervention took place from June 2010-July 2013 at the intervention site (Houston VA) and the control site (San Antonio VA).  Our two outcomes were total urine cultures (screening for ASB) and use of antibiotics for bacteriuria (treatment of ASB). At the Houston site, providers received case-based audit/ feedback using a CAUTI diagnosis and treatment algorithm derived from the Infectious Diseases Society of America guidelines.  Positive urine cultures related to urinary catheter use were classified as ASB or CAUTI. Use of antibiotics was “inappropriate” if given for ASB or if withheld for an episode of CAUTI.


    Urine culture ordering, a marker for unnecessary screening for ASB, decreased by 42% in Houston, from 49.87 cultures/bed-days prior to the intervention to 23.98 cultures/bed-days after the intervention, in comparison to a 0% decrease in San Antonio (p=0.04, Wilcoxon).  The combined outcome of inappropriate management of ASB and CAUTI in Houston decreased significantly over time (P<0.0001, Spearman), as have the individual outcomes of ASB treated inappropriately with antibiotics (P<0.0001, Spearman) and CAUTI managed inappropriately by withholding antibiotics (P<0.0001, Spearman).  For San Antonio, the decreases in these combined and individual outcomes were not statistically significant.


    Inappropriate screening for and treatment of catheter-associated ASB decreased during our campaign.  Under-treatment of CAUTI also decreased, implying that providers have improved their diagnostic accuracy at distinguishing CAUTI and ASB and their awareness of when antibiotics should be used. This audit/feedback intervention can potentially be disseminated by embedding it into existing antimicrobial stewardship programs.

    Aanand Naik, MD1, Nancy J. Petersen, MD, MPH2, Ashley J. Gendrett, BS, MPH3, Sylvia Hysong, PhD1, Jan E. Patterson, MD, FIDSA, FSHEA4,5 and Barbara W. Trautner, MD, PhD6, (1)Department of Veterans Affairs, Health Services Research & Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, Houston, TX, (2)Department of Veterans Affairs, Health Services Research & Development Center of Excellence, Michael E. Debakey VA Medical Center, Houston, TX, Houston, TX, (3)Health Services Research Center of Excellence At the Michael E. Debakey Veterans Affairs Medical Center, Houston, TX, (4)University of Texas Health Sciences Center, San Antonio, TX, (5)South Texas Veterans Health Care System, San Antonio, TX, (6)VA Health Services Research and Development Houston Center of Excellence, Michael E. Debakey VA Medical Center, Houston, TX


    A. Naik, None

    N. J. Petersen, None

    A. J. Gendrett, None

    S. Hysong, None

    J. E. Patterson, None

    B. W. Trautner, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.