1011. Knowledge of How to Manage Asymptomatic Bacteriuria Improves with Level of Training
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • ASB_Survey_Poster_IDSA_2013_(FINAL).png (405.7 kB)
  • Background:

    Inappropriate use of antibiotics to treat asymptomatic bacteriuria (ASB) is a significant contributor to antibiotic overuse in hospitalized patients.  We hypothesized that limited awareness of the IDSA’s ASB guidelines content as well as various social constructs would be associated with clinicians’ scores on a survey designed to test knowledge of how to manage asymptomatic bacteriuria.


    We designed a three-part survey instrument to assess providers’ self-efficacy, behavior, social norms, cognitive biases, general acceptance of guidelines, familiarity with and acceptance of the specific ASB guidelines through 36 items answered on a Likert scale.  A single question asked providers to self-report their familiarity with ASB guidelines content.  Finally, 17 knowledge questions posed case scenarios of bacteriuria and asked whether antibiotics were indicated (yes/no); the percentage of these questions answered correctly became the knowledge score.  The survey was administered to residents on internal medicine rotations and staff providers at the Houston VA hospital from June-September 2011.


    Of the 169 providers who took the survey, 15 were staff while 154 were residents.  The overall percent correct on the knowledge treatment score improved with level of training: 50.1 for year 1 residents, 61.0 for year 2 residents, 63.5 for year 3-4 residents, and 71.3 for staff (P<0.001 for year 1 compared to all other categories). Only 42% of respondents reported greater than minimal recall of ASB guidelines content. The following constructs also differed significantly between year 1 residents and staff: self-efficacy, behavior, and cognitive biases (P<0.01).  In multivariate analysis, behavior, cognitive biases, and year of training remained correlated with knowledge score (P<0.05).   


    Level of experience makes a difference in knowledge of how to manage catheter-associated bacteriuria according to evidence based guidelines.  Even with the highest average knowledge score, there is still much room for improvement even among staff.  Addressing both the knowledge gap and relevant cognitive biases earlier in residency training may lead to decreased inappropriate use of antibiotics to treat ASB.

    Aanand Naik, MD1, Sylvia Hysong, PhD1, Deborah Horwitz, MS, PA-C2, Nancy J. Petersen, MD, MPH3 and Barbara W. Trautner, MD, PhD4, (1)Department of Veterans Affairs, Health Services Research & Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, Houston, TX, (2)Baylor College of Medicine, Houston, TX, (3)Department of Veterans Affairs, Health Services Research & Development Center of Excellence, Michael E. Debakey VA Medical Center, Houston, TX, Houston, TX, (4)VA Health Services Research and Development Houston Center of Excellence, Michael E. Debakey VA Medical Center, Houston, TX


    A. Naik, None

    S. Hysong, None

    D. Horwitz, None

    N. J. Petersen, 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.