Despite clinical practice guidelines recommending against treatment for asymptomatic bacteriuria (ASB), health care providers continue to prescribe antibiotics for ASB in the hospital setting. We hypothesized that providing constant electronic feedback to providers after an initial educational session through antimicrobial stewardship program (ASP) would result in a significant decrease in inappropriate antimicrobial use (IAU) for ASB .
We conducted the study in a 909-bed tertiary care center with a formal ASP in place. ASP team reviewed charts at 72 hours after starting antimicrobials for appropriateness and left recommendations for the providers in the electronic health record (EHR) to discontinue antibiotics if not indicated. After obtaining the data of IAU for ASB and response to ASP’s recommendations at baseline during January 2015 to March 2015, a formal lecture was given on evidence based management of ASB to the providers in the departments of internal medicine, family medicine and hospitalist service. A template was developed in the EHR consisting of summary of best practice recommendations for managing ASB. Following the lectures in April 2015, ASP team started placing the template with discontinuation recommendation in the EHR whenever IAU was encountered for ASB. Follow up data on IAU for ASB and response to ASP’s recommendations were collected for the next 12 months. Linear regression analysis was used for the statistical analysis
During the baseline 3 months ASP team reviewed 849 charts of patients who were on antibiotics and 33 (3.8%) of them were treated for ASB inappropriately. After the intervention, a significant decrease in treatment of ASB was noticed (p=0.03) with 18 out of 540 patients (3.3%) being treated for ASB in first quarter post-intervention, followed by 16/589 (2.7%), 8/574 (1.39%) and 13/669 (1.9%) in second, third and fourth quarters respectively. Recommendations to stop antibiotic were rejected in 10.6% cases post-intervention versus 24.2% at baseline, but this difference did not reach statistical significance.
P. Cook, Merck: Grant Investigator and Speaker's Bureau , Research grant and Speaker honorarium
Gilead: Grant Investigator , Research grant
Pfizer: Grant Investigator , Research grant
M. S. Ashraf, None
M. Gooch, None
M. Jordan, None
S. Mohamed, None
J. Polak, None
D. Lebron, None
N. Fadul, None
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