Retrospective, multicenter, point prevalence study of urinary tract infection (UTI) data for a city-wide antimicrobial stewardship initiative
Methods: Four hospitals participated in this retrospective, multicenter, point prevalence survey using a standardized CDC-endorsed chart audit tool. Data were captured on a single day at each hospital in January or February 2014. Patients were included if they were receiving antimicrobial(s) for an indication of UTI per order indication or if not available, through positive urine culture (1 hospital). Data collected included demographics, presenting symptoms, urinalysis and urine culture, empiric and pathogen-guided treatment and total inpatient duration of therapy.
Results: Of 91 patients included, 59 (65%) were female. Hospital medicine service was the primary team for 61 (67%). Eighteen (20%) patients were asymptomatic and 29 (32%) presented with only one UTI related symptom. Commonly reported signs and symptoms included leukocytosis (27%), fever or rigors (23%) and new onset delirium (19%). Urine culture was obtained in 83 patients; Gram negative organisms (64%) were the most common pathogens. After applying McGeer Criteria to 66 patients without an indwelling urinary catheter, only 7 (11%) met both symptomatic and microbiological criteria for UTI. Ceftriaxone, ciprofloxacin and sulfamethoxazole-trimethoprim were the most commonly used antimicrobials for monotherapy. The median duration of therapy for those patients meeting McGeer Criteria was five days.
Conclusion: These results demonstrate an over-use of antimicrobials for UTI in the absence of diagnostic criteria. Using a standardized, CDC-endorsed chart audit tool facilitated rapid project implementation and led to timely identification of a stewardship intervention targeting appropriate diagnostics that could be implemented across a multi-institution collaborative.
M. L. Brundige, None
S. Patel, None
C. Evans, None
E. Rightmier, None
M. Staicu, None
C. Felsen, None
E. Dodds Ashley, None
G. Dumyati, None