Infectious Disease

Patients with asymptomatic bacteriuria frequently given inappropriate antibiotics

Evan Vega November 15, 2023

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November 14, 2023

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Key takeaways:

Of patients with a positive urine culture, 35% had no documented urinary tract infection-related symptoms.
Antibiotics were inappropriately prescribed for 75% of patients for asymptomatic bacteriuria.

Inappropriate antibiotic treatment for asymptomatic bacteriuria is common in critical access hospitals, researchers reported.

“Through the University of Washington Center for Stewardship in Medicine (UW-CSiM), many of us at the University of Washington have had the incredible opportunity to collaborate with community, rural, and critical access hospital partners since 2017,” Whitney Hartlage, PharmD, an infectious diseases clinical pharmacist at the University of Washington School of Pharmacy, told Healio.

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Hartlage W, et al. Infect Control Hosp Epidemiol. 2023;doi:10.1017/ice.2023.220.

“For this study, the Offices of Rural Health in Washington, Oregon, Idaho, Utah and Arizona approached us about supporting a quality improvement initiative to reinvigorate stewardship efforts within critical access hospitals (CAHs). After speaking with our sites and doing a preliminary study in collaboration with one of our infection prevention and control (IPC) colleagues who supports multiple CAHs within UW-CSiM, Barbara MacDonald, we identified that the inappropriate diagnosis and treatment of urinary tract infections (UTIs) is a common issue in this setting and the reason we chose this area to focus our efforts,” Hartlage said.

To assess diagnosis and treatment patterns, Hartlage and colleagues performed a multisite, quality improvement study of 17 CAHs participating in the UW-CSiM. Abstractors at each CAH retrospectively identified and collected data from patients aged 18 years and older with a urine culture collected during an ambulatory or inpatient health care encounter between Sept. 1, 2021, and June 10, 2022, using a REDCap electronic data collection tool.

The primary outcomes were the prevalence of asymptomatic bacteriuria (ASB) and proportion of ASB cases that received antibiotic treatment.

In total, the researchers reviewed data for 1,087 patients with urine cultures, though only 891 were included in the study for various reasons including missing data, age and pregnancy. Among 486 patients with a positive urine culture, 170 (35%) had ASB, and 129 (76%) received antibiotics.

Overall, the study showed that the ED was the most common location for urine culture collection (72%), 35% of patients with a positive urine culture had no documented UTI-related symptoms and 75% of patients were inappropriately prescribed antibiotics for ASB for a median duration of 7 days.

Data also showed that among the 129 patients with ASB treated with antibiotics, oral antibiotics were prescribed for 105 (81%), with beta-lactams being the most frequently prescribed (45%), followed by nitrofurantoin (19%) and fluoroquinolones (18%). Of the 55 patients who received intravenous antibiotic therapy, 98% received beta-lactams.

“Data to guide stewardship interventions in rural and critical access hospitals is extremely limited. These hospitals face unique challenges, therefore, an improved awareness of testing and prescribing practices of antimicrobials in this setting is needed,” Hartlage said. “Based on these findings, we were able to identify important areas to focus stewardship interventions in CAHs, including unnecessary antibiotic use in patients with ASB and long duration of therapy in treated patients.”

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