1005. Modified reporting of positive urine cultures from non-catheterized inpatients as a strategy to reduce antimicrobial therapy for asymptomatic bacteriuria: a controlled time series analysis
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background: Asymptomatic bacteriuria (ASB) is a common cause of unnecessary antimicrobial therapy among hospitalized patients and previous quality improvement initiatives have had limited success. At our institution, urinary tract infection (UTI) is present in the minority of non-catheterized medical/surgical inpatients for whom cultures are submitted.  ASB detected by these cultures leads to antimicrobial therapy in half of patients.

Methods: A modified report for positive non-catheterized urine cultures asking clinicians to call for the results if they suspect UTI was evaluated among medical/surgical inpatients using a time series analysis.  All patients with positive urine cultures were independently assessed within 24 hours for presence of UTI by CDC criteria. Antimicrobial prescriptions were documented at 72 hours. The primary outcome was the treatment rate of ASB among non-catheterized inpatients before and after intervention, compared with catheterized controls. Process measures included the number of urine cultures reported and the number of mislabeled catheter specimens. Balancing measures included the number of calls to the laboratory, occurrence of any untreated UTIs, and sepsis among untreated patients at 72 hours.

Results: The baseline rate of antimicrobial therapy for ASB among non-catheterized and catheterized inpatients was 10/20 (50%) and 9/17 (53%), respectively. During the 30-day intervention, 23 non-catheterized urine culture reports were modified; 21 patients had ASB and 2 patients had UTI. Treatment of ASB among non-catheterized patients decreased to 14% (3/21), and remained at 50% (11/22) among catheterized controls (relative risk reduction, 0.72; absolute risk reduction, 0.36; p=0.02). Mislabeling of catheter specimens occurred in 19% (5/26) of patients. An average of 1 call per week was placed to the microbiology laboratory to request results. There was no untreated UTI or sepsis arising in non-catheterized patients.

Conclusion: A modified urine culture report for positive non-catheterized specimens from medical/surgical inpatients asking clinicians to call for results led to a greater than 70% decrease in antimicrobial therapy without unintended consequences. Further study is needed to better evaluate sustainability and safety of this intervention.

Jerome Leis, MD, Gabriel Rebick, MD, Nick Daneman, MD, MSc, Wayne Gold, MD, FRCPC, Pauline Lo, Susan Poutanen, MD FRCP(C), Mirek Otremba, MD, Kaveh Shojania, MD and Allison McGeer, MD, MSc, FRCPC, FSHEA, University of Toronto, Toronto, ON, Canada

Disclosures:

J. Leis, None

G. Rebick, None

N. Daneman, None

W. Gold, None

P. Lo, None

S. Poutanen, None

M. Otremba, None

K. Shojania, None

A. McGeer, None

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