1025. Assessment of physicians’ knowledge and practice regarding antibiotic use for asymptomatic bacteriuria
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background:

Asymptomatic bacteriuria (ABU) is common and often leads to inappropriate antimicrobial use. This study was designed to investigate the appropriateness of antibiotic use for ABU and to explore the knowledge and practice of the physicians involved in the process of prescribing antibiotics for ABU.

Methods:  We reviewed medical records of all inpatients with >105 colony-forming units/mL bacteria on urine culture at a 900-bed university affiliated hospital from January to December 2011. ABU and appropriate therapy were defined according to the 2005 IDSA guidelines. Multivariate analysis using logistic regression was applied to evaluate factors associated with inappropriate treatment of ABU. To assess physician practices and perceptions related to ABU, we conducted a survey for residents primarily caring for inpatients.

Results:

We identified 222 cases of ABU among a total of 1167 positive urine cultures. Of these 222 cases, 73 (32.9%) were inappropriately treated. Female sex, pyuria, hematuria, nitrite positivity on urinalysis were associated with unnecessary antimicrobial use for ABU.

On the survey, 95 of 128 physicians (74%) responded. Only 33% of responders were able to distinguish ABU from urinary tract infection (UTI) and 46% showed discordant practice with knowledge. Specialties and years in practice were not associated with the discordance. Reasons for inappropriately prescribing antibiotics for ABU were as follows; eradication of a possible infection source before surgery (39%), as a routine practice (23%), and prevention of symptomatic UTIs (9%).

Urine cultures in asymptomatic patients, which might contribute to inappropriate treatment, were mostly ordered during work up for hidden infections (78%) or urinary abnormalities (57%). Routine urine cultures during systemic antibiotic treatment for other concomitant infections (23%) or for surveillance in the intensive care unit (8%) were other reasons.

Conclusion:

About one third of ABUs were inappropriately treated in our hospital. Lack of knowledge and inconsistency between perception and practice regarding ABU highlight the importance of educational interventions.

Myung Jin Lee, MD1, Younghee Jung, MD1, Moonsuk Kim, MD1, Shinhye Cheon, MD1, Chung-Jong Kim, MD2, Nak-Hyun Kim, MD3, Kyoung-Ho Song4, Pyoeng Gyun Choe, MD4, Ji-Hwan Bang, MD, PhD5, Wan Beom Park, MD, PhD1, Eu Suk Kim4, Sang-Won Park, MD, PhD1, Nam Joong Kim, MD, PhD1, Myoung-Don Oh, MD, PhD1 and Hong Bin Kim4, (1)Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea, (2)Seoul National University Bundang Hospital, Seongnam, South Korea, (3)Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea, (4)Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea, (5)Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea

Disclosures:

M. J. Lee, None

Y. Jung, None

M. Kim, None

S. Cheon, None

C. J. Kim, None

N. H. Kim, None

K. H. Song, None

P. G. Choe, None

J. H. Bang, None

W. B. Park, None

E. S. Kim, None

S. W. Park, None

N. J. Kim, None

M. D. Oh, None

H. B. Kim, None

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