1499. Impact of Urine Testing on Unnecessary Antibiotic use for Asymptomatic Bacteriuria
Session: Poster Abstract Session: Antimicrobial Stewardship: Role of Diagnostics
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Poster rough draft4_jcm_mre.pdf (247.7 kB)
  • Background:

    Antibiotic prescribing for asymptomatic bacteriuria (ASB) remains a major source of unnecessary prescribing; high occurrence of urine testing and ambiguity in interpretation of results may be contributing factors. Our objective was to characterize the frequency of antibiotic use for ASB by type of urine test ordered and evaluate concordance between test results and antibiotic use.

    Methods:

    We conducted a retrospective cross-sectional study of patients (age ≥ 18) hospitalized >24 hours on medical and surgical services at our institution between January and March 2015. Patients with orders for microscopy/urine analysis with reflex to culture or adult urinary tract infection (UTI) panel (dipstick with reflex to culture) were included. We considered individuals’ first hospitalization and excluded pregnant, urological, and transplant patients.  Patients were compared across order type (Chi-square test) for temperature ≥ 36C (“fever”), white blood cell (WBC) count above 11,000, source of urine sample, documentation of a clinical indication of UTI (i.e., abdominal pain, burning or pain with urination, urgency, hesitancy or frequency), and initiation of antimicrobials.

    Results:

    A total of 2598 patients were identified for inclusion; 2137 (82.3%) received an adult UTI panel, and the remaining 461 (17.7%) received microscopy and/or urine analysis testing. Fever or elevated WBC was present in 6.2% of adult UTI panel versus 5.9% of microscopy/urine analysis patients (p=0.77).  The proportion of patients receiving ≥ 1 antibiotic among those without fever or elevated WBC was similar among adult UTI panel (26.1%) versus microscopy/urine analysis patients (27.2%; p=0.64). Within the adult UTI panel group, 64.6% had test results not clearly indicative of a UTI; of those patients, 34.1% received antibiotic therapy.

    Conclusion: At our institution, potentially unnecessary antibiotic use was similar among patients receiving the adult UTI panel and those with microscopy/urine analysis.  Overall, prescribing of antibiotics was common among patients where diagnostic results were not indicative of UTI. We plan to use this information to identify areas for intervention and thereby lessen inappropriate antibiotic use.

    Corinne Klein, MD, Infectious Diseases, Oregon Health and Sciences University, Portland, OR, Miriam R. Elman, MPH, Dept. of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, OR, Adam Brady, MBBChBAO, Div. of Infectious Diseases, Oregon Health & Sciences University, Portland, OR, James Lewis II, PharmD, FIDSA, Pharmacy, Oregon Health and Science University, Portland, OR, Erin Bonura, MD, Internal Medicine, Oregon Health & Science University, Portland, OR and Jessina C. Mcgregor, PhD, Dept. Pharmacy Practice, Oregon State University College of Pharmacy, Portland, OR

    Disclosures:

    C. Klein, None

    M. R. Elman, None

    A. Brady, None

    J. Lewis II, Astellas: Consultant , Consulting fee
    Cubist: Consultant , Consulting fee
    Theravance: Consultant , Consulting fee
    Accelerate: Consultant , Consulting fee
    Forest: Consultant , Consulting fee

    E. Bonura, None

    J. C. Mcgregor, Cubist: Speaker's Bureau , honoria

    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.