168. Appropriateness of treatment of Gram-negative bacteriuria in a large academic hospital
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
Background: Patients with positive urine cultures (bacteriuria) may present with symptoms consistent with urinary tract infection (UTI) or have asymptomatic bacteriuria (ASB). Infectious Diseases Society of America guidelines recommend against antimicrobial treatment of ASB in most patients; however, determining appropriate treatment at initial presentation may be difficult, particularly for patients with multiple co-morbidities.  We assessed appropriateness of treatment of patients with Gram-negative monomicrobial bacteriuria at a Boston teaching hospital.  

Methods: Clinical data associated with 245 positive urine cultures collected between 8/2013 – 1/2014, in a previous susceptibility study, were recorded.   Isolates consisted of Pseudomonas aeruginosa (n = 26), Escherichia coli (n = 150), Klebsiellaspp. (n = 44), and other Enterobacteriaceae (n = 25).  Clinical characteristics, microbiology and urinalysis results, treatment, and documented UTI symptoms were collected.  Frequency of empirical antibiotic treatment (within 72 hours of index culture) was assessed for appropriateness.  

Results: One hundred forty-six (59.6%) patients had documented symptoms and 99 (40.4%) were asymptomatic. Patient groups were similar with regard to sex and co-morbidities, however patients with ASB were statistically older (71.3 ± 16.3 vs 62.7 ± 21.5 years, p = 0.001) with slightly higher median APACHE II scores (10 vs 8; p = 0.01).  ASB patients had an overall longer length of stay (LOS) (9.1 ± 11.8 vs 5.8 ± 7.3 days; p = 0.03), yet there was no difference between LOS prior to index culture.  In patients (n = 208) with no other positive cultures within 7 days of index cultures, rates of empirical antibiotic treatment were high, however, symptomatic patients were more often treated (73.0% vs 92.4%; p<0.001). Of note, 21.7% of ASB patients were continued on therapy longer than 72 hours.   

Conclusion: Clinical characteristics of patients who were found to have monomicrobial bacteriuria were similar regardless of UTI symptoms. At this time, local antimicrobial stewardship initiatives do not include active surveillance for ASB treatment. The high rate of treatment of ASB demonstrates the need for education and feedback at our institution.

Brian R. Raux, BS1, Alessandra Lyman, BS, PharmD1, Emily Walker, BS, PharmD1, Jordan Liscio, BS, PharmD1, Christopher McCoy, PharmD, BCPS2, George M. Eliopoulos, MD, FIDSA3 and Elizabeth B. Hirsch, PharmD, BCPS1,2, (1)Northeastern University, Boston, MA, (2)Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, (3)Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA


B. R. Raux, None

A. Lyman, None

E. Walker, None

J. Liscio, None

C. McCoy, Actavis: Grant Investigator , Grant recipient and Research grant

G. M. Eliopoulos, Durata/Actavis: Consultant , Consulting fee

E. B. Hirsch, Actavis: Grant Investigator , Research support
Theravance Biopharma: Scientific Advisor , Speaker honorarium

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