960. Inappropriate Testing and Treatment of Asymptomatic Bacteriuria: Assessment of Provider Behavior and the Effectiveness of an Audit and Feedback Intervention in the Hospital
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
Posters
  • IDSA SS 2016.pdf (371.8 kB)
  • Background:

    Asymptomatic bacteriuria (ASB) is commonly treated despite recommendations against this practice. Our aim was to evaluate provider knowledge and behavior regarding unnecessary testing and treatment of ASB and assess the impact of an educational intervention.

    Methods:

    A multiple choice, case-based survey was performed to assess internal medicine resident knowledge of ASB and indications for obtaining urine cultures. Retrospective chart review was performed to identify a one-month pre-intervention patient cohort from two medicine wards. The two-month intervention was “real-time” audit and feedback for providers who ordered urine cultures. Exclusion criteria were pregnancy, kidney transplant, nephrostomy tube, ureteral stent, and invasive urological procedures. Urinary tract infection (UTI) was defined as bacteriuria with urinary symptoms or SIRS with no other identifiable infection source in a patient who is unable to communicate. ASB was defined as bacteriuria without these conditions.

    Results:

    The survey was completed by 50% of the internal medicine residents; 70% would send urine cultures without an indication, and 40% would treat ASB. The pre-intervention cohort included 162 cultures in April 2015. During the intervention phase in January and February 2016, there were 186 urine cultures. We observed a significant improvement in appropriate urine cultures and a decrease in detection of ASB; however rates of treatment of ASB were similar (Table 1). There was a 43% reduction in urine cultures per month during the intervention phase.

     

    Pre-intervention (n=162)

    Intervention (n=186)

    p-value

    Appropriate clinical indication for urine culture

    36 (22%)

    65 (35%)

    0.029

    ASB detection

    53 (33%)

    39 (21%)

    0.040

    ASB treatment

    12/53 (23%)

    12/39 (31%)

    0.91

    Conclusion:

    Compatible with the survey results, the pre-intervention cohort demonstrated frequent inappropriate urine culture testing and inappropriate antibiotic use for ASB. During our intervention, we observed an estimated 43% reduction in the number of urine cultures per month and a significant reduction in the detection of ASB. However, there was no change in the percentage of patients with ASB who were treated highlighting the importance of decreasing unnecessary urine culture testing.

    Sarah Schaefer, MD1, Allison Glaser, MD2, Lindsey Gottlieb, MD2 and Shirish Huprikar, MD3, (1)Infectious Diseases, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, (2)Internal Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, (3)Medicine, Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY

    Disclosures:

    S. Schaefer, None

    A. Glaser, None

    L. Gottlieb, None

    S. Huprikar, None

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