164. Overtreatment of Asymptomatic Bacteriuria:†a Qualitative Study
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Overtreatment of Asymptomatic Bacteriuria_A Qualitative Study.pdf (197.8 kB)
  • Background: Overtreatment of asymptomatic bacteriuria (ASB) is common and can result in antibiotic side effects, excess costs to the healthcare system, and potentially trigger antimicrobial resistance. According to international management guidelines, ASB is not an indication for antibiotic treatment (with few exceptions). Our objective was to determine reasons for using antibiotics to treat ASB in the absence of a treatment indication.

    Methods: We conducted a qualitative study at a tertiary care hospital in Switzerland during 2011. We interviewed 21 internal medicine residents and attending physicians selected by purposive sampling, using a semi-structured questionnaire. Responses were analyzed in an inductive thematic content approach using dedicated software (MAXQDA®).

    Results: In the 21 interviews, the following thematic rationales for antibiotic overtreatment of ASB were reported (in order of reporting frequency): 1) Treating laboratory findings without taking the clinical picture into account (n=17); 2) Psychological factors such as anxiousness, overcautiousness or anticipated positive impact on patient outcomes (n=13); 3) External pressors such as institutional culture, peer pressure, patient expectation, and excessive workload that interferes with proper decision-making (n=9); 4) Difficulty with interpreting clinical signs and symptoms (n=8).

    Conclusion: In this qualitative study we identified both physician-centered factors (e.g., overcautiousness) and external pressors (e.g., excessive workload) as motivators for prescribing unnecessary antibiotics. Also, we interpreted the frequently cited practice of treating asymptomatic patients based on laboratory findings alone as lack of awareness of evidence-based best practices.

    Myriam Eyer, MD1,2, Matthias Lšng, MD1, Drahomir Aujesky, MD3 and Jonas Marschall, MD1, (1)Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland, (2)Division of Infectious Diseases, Valais Hospital, Sion, Switzerland, (3)Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland

    Disclosures:

    M. Eyer, None

    M. Lšng, None

    D. Aujesky, None

    J. Marschall, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.