Highlights
- •Asymptomatic bacteriuria was highly prevalent (64%) in this Veteran population.
- •Twenty-eight percent of asymptomatic bacteriuria cases were inappropriately prescribed antimicrobials.
- •Abdominal pain, falls, decreased urine output and voiding issues were related to treatment.
- •Stewardship programs can incorporate these findings to reduce unnecessary treatment.
Abstract
Background
Chart reviews often fall short of determining what drove antibiotic treatment of asymptomatic
bacteriuria (ASB). To overcome this shortcoming, we searched providers’ free-text
for documentation of their decision-making and for misleading signs and symptoms that
may trigger unnecessary treatment of ASB.
Methods
We reviewed a random sample of 10 positive urine cultures per month, per facility,
from patients in acute or long-term care wards at 8 Veterans Affairs facilities. Cultures
were classified as urinary tract infection (UTI) or ASB, and as treated or untreated.
Charts were searched for 13 potentially misleading symptoms, and free-text documentation
of providers’ decision-making was classified into 5 categories. We used generalized
estimating equations logistic regression to identify factors associated with ASB treatment.
Results
One hundred fifty-eight (27.5%) of 575 ASB cases were inappropriately treated with
antibiotics. Significant factors associated with inappropriate treatment included:
abdominal pain, falls, decreased urine output, urine characteristics, abnormal vital
signs, laboratory values, and voiding issues. Providers prescribed an average of 1.4
antimicrobials to patients with ASB, with cephalosporins (41%) and fluoroquinolones
(21%) being the most common classes prescribed.
Conclusions
Chart reviews of providers’ decision-making highlighted new factors associated with
inappropriate ASB treatment. These findings can help design antibiotic stewardship
interventions for ASB.
Key Words
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Article Info
Publication History
Published online: February 11, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of Interest: We have listed all funding sources and any potential conflicts of interest in the submitted ICMJE forms; however, we believe none of these pose conflicts of interest to this work.
Funding: This work is supported by VA HSR&D IIR 16-025 (to BWT) and by the Center for Innovations in Quality, Effectiveness, and Safety ( CIN 13-413 ) at the Michael E. DeBakey VA Medical Center, Houston, Texas, USA. MVK is supported in part by the Health Resources and Services Administration, an agency of the US Department of Health and Human Services (grant number T32 HP10031 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the US Department of Veterans Affairs.
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© 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
