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Modified Reporting of Positive Urine Cultures to Reduce Inappropriate Treatment of Asymptomatic Bacteriuria Among Nonpregnant, Noncatheterized Inpatients: A Randomized Controlled Trial

Published online by Cambridge University Press:  28 May 2018

Peter Daley ,
David Garcia ,
Raheel Inayatullah ,
Carla Penney  and
Sarah Boyd
Peter Daley*
Affiliation:
Memorial University of Newfoundland Department of Clinical Epidemiology, St John’s, Newfoundland, Canada Memorial University of Newfoundland Department of Medicine, St John’s, Newfoundland, Canada; Canada A1B3V6 ([email protected]).
David Garcia
Affiliation:
Memorial University of Newfoundland Department of Clinical Epidemiology, St John’s, Newfoundland, Canada
Raheel Inayatullah
Affiliation:
Memorial University of Newfoundland Department of Medicine, St John’s, Newfoundland, Canada; Canada A1B3V6 ([email protected]).
Carla Penney
Affiliation:
Memorial University of Newfoundland Department of Clinical Epidemiology, St John’s, Newfoundland, Canada
Sarah Boyd
Affiliation:
Memorial University of Newfoundland Department of Clinical Epidemiology, St John’s, Newfoundland, Canada
*
Address correspondence to Peter Daley, Associate Professor of Medicine, Memorial University of Newfoundland, Room 1J421, 300 Prince Phillip Dr, St John’s, Newfoundland,
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Abstract

DESIGN

We conducted a randomized, parallel, unblinded, superiority trial of a laboratory reporting intervention designed to reduce antibiotic treatment of asymptomatic bacteriuria (ASB).

METHODS

Results of positive urine cultures from 110 consecutive inpatients at 2 urban acute-care hospitals were randomized to standard report (control) or modified report (intervention). The standard report included bacterial count, bacterial identification, and antibiotic susceptibility information including drug dosage and cost. The modified report stated: “This POSITIVE urine culture may represent asymptomatic bacteriuria or urinary tract infection. If urinary tract infection is suspected clinically, please call the microbiology laboratory … for identification and susceptibility results.” We used the following exclusion criteria: age <18 years, pregnancy, presence of an indwelling urinary catheter, samples from patients already on antibiotics, neutropenia, or admission to an intensive care unit. The primary efficacy outcome was the proportion of appropriate antibiotic therapy prescribed.

RESULTS

According to our intention-to-treat (ITT) analysis, the proportion of appropriate treatment (urinary tract infection treated plus ASB not treated) was higher in the modified arm than in the standard arm: 44 of 55 (80.0%) versus 29 of 55 (52.7%), respectively (absolute difference, −27.3%; RR, 0.42; P = .002; number needed to report for benefit, 3.7).

CONCLUSIONS

Modified reporting resulted in a significant reduction in inappropriate antibiotic treatment without an increase in adverse events. Safety should be further assessed in a large effectiveness trial before implementation

TRIAL REGISTRATION. clinicaltrials.gov#NCT02797613

Infect Control Hosp Epidemiol 2018;814–819

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 7 , July 2018 , pp. 814 - 819
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

REFERENCES

1. Zalmanovici Trestioreanu, A, Lador, A, Sauerbrun-Cutler, MT, Leibovici, L. Antibiotics for asymptomatic bacteriuria. Cochrane Database Syst Rev 2015;4:CD009534.Google ScholarPubMed
2. Nicolle, LE, Bradley, S, Colgan, R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643–654.CrossRefGoogle Scholar
3. Leis, JA, Rebick, GW, Daneman, N, et al. Reducing antimicrobial therapy for asymptomatic bacteriuria among noncatheterized inpatients: a proof-of-concept study. Clin Infect Dis 2014;58:980–983.CrossRefGoogle ScholarPubMed
4. Stagg, A, Lutz, H, Kirpalaney, S, et al. Impact of two-step urine culture ordering in the emergency department: a time series analysis. BMJ Qual Saf 2017:1–8; doi: 10.1136/bmjqs-2016-006250.Google ScholarPubMed
5. Centers for Disease Control and Prevention. Urinary tract infection (catheter-associated urinary tract infection [CAUTI] and non-catheter-associated urinary tract infection [UTI]) and other urinary system infection [USI]) events In: Network NHS, ed. Atlanta: CDC; 2017.Google Scholar
6. Urbaniuk, GC, Plous, S. Research Randomizer (version 4.0) software website. http://www.randomizer.org/. Published 2015. Accessed December 15, 2016.Google Scholar
7. Irfan, N, Brooks, A, Mithoowani, S, Celetti, SJ, Main, C, Mertz, D. A controlled quasi-experimental study of an educational intervention to reduce the unnecessary use of antimicrobials for asymptomatic bacteriuria. PloS One 2015;10:e0132071.CrossRefGoogle ScholarPubMed
8. Trautner, BW, Grigoryan, L, Petersen, NJ, et al. Effectiveness of an antimicrobial stewardship approach for urinary catheter-associated asymptomatic bacteriuria. JAMA Intern Med 2015;175:1120–1127.CrossRefGoogle ScholarPubMed
9. Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Executive summary: implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:1197–1202.CrossRefGoogle Scholar
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