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Evaluating a Hospitalist-Based Intervention to Decrease Unnecessary Antimicrobial Use in Patients With Asymptomatic Bacteriuria

Published online by Cambridge University Press:  06 June 2016

Sarah E. Hartley ,
Latoya Kuhn ,
Staci Valley ,
Laraine L. Washer ,
Tejal Gandhi ,
Jennifer Meddings ,
Michelle Robida ,
Salas Sabnis ,
Carol Chenoweth  and
Anurag N. Malani
...Show all authors
Sarah E. Hartley
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan Veterans’ Administration Ann Arbor Healthcare System, Ann Arbor, Michigan
Latoya Kuhn
Affiliation:
Veterans’ Administration Ann Arbor Healthcare System, Ann Arbor, Michigan Veterans’ Affairs/University of Michigan Patient Safety Enhancement Program (PSEP), Ann Arbor, Michigan
Staci Valley
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Laraine L. Washer
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan Department of Infection Prevention and Epidemiology, University of Michigan, Ann Arbor, Michigan
Tejal Gandhi
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Jennifer Meddings
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan Veterans’ Affairs/University of Michigan Patient Safety Enhancement Program (PSEP), Ann Arbor, Michigan
Michelle Robida
Affiliation:
St. Joseph Mercy Hospital, Ann Arbor, Michigan
Salas Sabnis
Affiliation:
St. Joseph Mercy Hospital, Ann Arbor, Michigan
Carol Chenoweth
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Anurag N. Malani
Affiliation:
St. Joseph Mercy Hospital, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan Veterans’ Administration Ann Arbor Healthcare System, Ann Arbor, Michigan Veterans’ Affairs/University of Michigan Patient Safety Enhancement Program (PSEP), Ann Arbor, Michigan
Scott A. Flanders
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Abstract

OBJECTIVE

Inappropriate treatment of asymptomatic bacteriuria (ASB) in the hospital setting is common. We sought to evaluate the treatment rate of ASB at the 3 hospitals and assess the impact of a hospitalist-focused improvement intervention.

DESIGN

Prospective, interventional trial.

SETTING

Two community hospitals and a tertiary-care academic center.

PATIENTS

Adult patients with a positive urine culture admitted to hospitalist services were included in this study. Exclusions included pregnancy, intensive care unit admission, history of a major urinary procedure, and actively being treated for a urinary tract infection (UTI) at the time of admission or >48 hours prior to urine collection.

INTERVENTIONS

An educational intervention using a pocket card was implemented at all sites followed by a pharmacist-based intervention at the academic center. Medical records of the first 50 eligible patients at each site were reviewed at baseline and after each intervention for signs and symptoms of UTI, microbiological results, antimicrobials used, and duration of treatment for positive urine cultures. Diagnosis of ASB was determined through adjudication by 2 hospitalists and 2 infectious diseases physicians.

RESULTS

Treatment rates of ASB decreased (23.5%; P=.001) after the educational intervention. Reductions in treatment rates for ASB differed by site and were greatest in patients without classic signs and symptoms of UTI (34.1%; P<.001) or urinary catheters (31.2%; P<.001). The pharmacist-based intervention was most effective at reducing ASB treatment rates in catheterized patients.

CONCLUSIONS

A hospitalist-focused educational intervention significantly reduced ASB treatment rates. The impact varied across sites and by patient characteristics, suggesting that a tailored approach may be useful.

Infect Control Hosp Epidemiol 2016;37:1044–1051

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 9 , September 2016 , pp. 1044 - 1051
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. Preliminary data were reported as an abstract at the Society of Hospital Medicine Annual Meeting in Las Vegas, Nevada, on March 25, 2014.

References

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