Antibiotic Stewardship Program for Asymptomatic Bacteriuria Associated with Fewer Days of Antibiotics and Shorter Length of Antibiotic Therapy
One of the important targets for antimicrobial stewardship is inappropriate treatment of asymptomatic bacteriuria (ASB), or bacteria in the urinary tract without related symptoms. Despite multiple evidence-based guidelines that recommend against culturing the urine to screen and treat ASB with antimicrobials, treatment of ASB is very common. This study evaluated the effectiveness of a quality improvement stewardship intervention on reducing unnecessary urine cultures and antibiotic use among Veterans with ASB. Investigators compared four intervention sites with four comparison sites from October 2017 through April 2020. The intervention included case-based teaching on how to apply an evidence-based algorithm to distinguish urinary tract infection and ASB and was delivered at a distance in this study. A central coordinating center provided external facilitation (e.g., organizing monthly meetings for the four local site teams), and a site champion at each intervention site served as an internal facilitator. Veterans in this study (n = 11,299) included those admitted to a VA acute care medicine ward or residing in a VA community living center long-term care unit during the study period, which encompassed 900,437 bed-days. Outcomes were the total number of urine cultures ordered by inpatient or long-term care providers and antimicrobial use.
- The antibiotic stewardship intervention was associated with significantly fewer urine cultures ordered and shorter length of antibiotic therapy.
- Urine cultures decreased from 15 to 12 per 1,000 bed-days in the intervention sites. Days of antibiotic therapy decreased from 46 to 37 per 1,000 bed-days (22% decrease).
- In contrast, there was a significant increase in urine cultures and days of antibiotic therapy in the comparison sites.
- The success of this project implies that external/internal facilitation is a viable strategy for implementing antibiotic stewardship at a distance.
- The primary outcome was total urine cultures ordered; this metric does not take into account whether the cultures were appropriate or not.
This study was partly funded by HSR&D (IIR 16-025). Drs. Grigoryan, Naik and Trautner are part of HSR&D’s Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) in Houston, TX.
Grigoryan L, Naik A, Lichtenberger P, et al., and Trautner B. Analysis of an Antibiotic Stewardship Program for Asymptomatic Bacteriuria in the Veterans Affairs Healthcare System. JAMA Network Open. July 25, 2022;5(7):e2222530.