Electronic Memorandum Decreases Unnecessary Antimicrobial Use for Asymptomatic Bacteriuria and Culture-Negative Pyuria

Veterans Affairs Boston Health Care System, Boston, Massachusetts 02132, USA.
Infection Control and Hospital Epidemiology (Impact Factor: 4.18). 07/2011; 32(7):644-8. DOI: 10.1086/660764
Source: PubMed


Asymptomatic bacteriuria/candidiuria (ASB) and culture-negative pyuria (CNP) are common and often result in inappropriate antibiotic use. We aimed to evaluate whether a standardized educational memorandum could reduce antimicrobial utilization for ASB/CNP.
Quasi-experimental study with a control group, from a convenience sample of inpatients with abnormal urinalysis or urine culture results in a Veterans Affairs hospital.
An educational memorandum outlining guidelines for diagnosis and treatment of ASB was placed in the chart of patients with ASB/CNP who were receiving antimicrobials.
The records of patients meeting inclusion criteria were abstracted for demographics, comorbidities, antimicrobials, and symptoms suggestive of possible urinary tract infection (UTI). Patients were categorized as having ASB, CNP, or UTI. The number of antimicrobial-days attributed to ASB/CNP was compared between the control group and the intervention group.
Charts of 301 patients with abnormal urine results were reviewed. Thirty of 117 (26%) patients in the control group received antimicrobials for ASB/CNP for an average of 6.3 days. In the intervention group, 24 of 92 (26%) patients received antimicrobials for ASB/CNP for an average of 2.2 days (t-test: P < .001). Adverse events from antimicrobials for ASB/CNP occurred in 3 of the 30 (10%) patients in the control group. There were no adverse events from untreated ASB/CNP in the intervention group.
ASB and CNP resulted in antimicrobial exposure in more than one-quarter of our study patients. Placing a standardized memorandum in the electronic record was associated with a 65% relative reduction in antimicrobial-days for ASB and CNP.

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Available from: Kalpana Gupta, Feb 11, 2015
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    • "The findings in our study are also comparable to studies utilizing both educational and non-educational interventions (11–15, 18–20). Our study, like others, involved pre- and post-intervention assessments of inappropriate treatment (11, 14). Furthermore, the studies strived to maintain similar pre- and post-intervention populations in terms of their baseline characteristics, and had similar exclusion criteria as to which sub-sets of the population should be treated for ASB (1). "
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