Program Schedule

139
Descriptive study of patterns of urine testing and antibiotic use in an inpatient physical medicine and rehabilitation population

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • FINAL. ID Week 2014.Andrzejewski.Christina.pdf (228.8 kB)
  • Background: Asymptomatic bacteriuria (ASB) is common in patients admitted to inpatient rehabilitation (IPR) units. Current guidelines recommend against routine urine testing in asymptomatic patients, including patients with spinal cord injuries (SCI). Screening for urinary tract infections (UTI) is prompted by subjective observations that may not relate to infection; however, a positive urine screen frequently prompts antimicrobial prescribing even in the absence of symptoms.

    Methods: A retrospective case control study was conducted at a university-affiliated academic medical center with a 76-bed IPR unit. 181 IPR patients hospitalized between 8/2013 and 10/2013 were randomly selected. The documented reasons for urine testing and results, antibiotic use, demographic information, comorbidities, and urinary catheter data were collected. SAS V9.3 was used to analyze the data. The primary objective was to determine patient factors that prompted screening and treatment and to document specific UTI symptoms. A secondary objective was to describe appropriateness of antimicrobial use.

    Results: 104 patients had orders for urinalysis and/or culture. Only 17 patients (16.3%) who were screened had specific UTI symptoms as defined by the National Health Safety Network (NHSN). Among the 61 patients who were ordered antibiotics, 38 patients had ASB (62.3%). Neurogenic bladder in SCI patients is a known risk factor for UTI. Of those screened in our study, 36 patients (35%) had documented neurogenic bladder, while 10 (13%) patients without screening had neurogenic bladder (OR=3.4, 95% CI=1.6-7.4, p=0.002). Results from a multivariate analysis determined the following factors associated with urine screening.

    Variable

    OR

    95% CI

    p-value

    Actual LOS

    Per week (7 days)

    2.1

    (1.4, 3.2)

    0.0006

    WBC Count

    ≥11,000

    4.6

    (1.4, 15.8)

    0.014

    Symptoms

    153.4*

    (32.5, ∞)

    <.0001

    IPR Unit

    General

    Baseline

    0.018

    Stroke

    4.2

    (1.3, 13.9)

    SCI

    1.8

    (0.6, 5.6)

    Traumatic Brain Injury

    0.14

    (0.01, 2.4)

    Conclusion: The primary use of antimicrobial agents on the IPR units at our institution is for the treatment of ASB. The practice of routine urine screening for asymptomatic patients should be revisited. This project identifies an opportunity for targeted antimicrobial stewardship efforts.

    Christina Andrzejewski, PharmD1, Kathleen Shutt, MS2, Henry Freedy, PharmD1, Gary Galang, MD3 and Mohamed Yassin, MD, PhD4, (1)Pharmacy, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA, (2)Medicine, University of Pittsburgh Division of Infectious Diseases, Pittsburgh, PA, (3)Department of Physical Medicine & Rehabilitation, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA, (4)Medicine, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA

    Disclosures:

    C. Andrzejewski, None

    K. Shutt, None

    H. Freedy, None

    G. Galang, None

    M. Yassin, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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