Preventing the inappropriate treatment of asymptomatic bacteriuria at a community teaching hospital

• Main Authors: Farhana Chowdhury, Kumkum Sarkar, Angela Branche, Juliette Kim, Philip Dwek, Angelica Nangit, David Tompkins, Ernest Visconti
• Format: Article
• Language: English
• Published: Taylor & Francis Group 2012-07-01
• Series: Journal of Community Hospital Internal Medicine Perspectives
• Subjects: practice guidelines as topic; guideline adherence; trends; urinary tract infections; economics; prevention and control; disease management
• Online Access: http://www.jchimp.net/index.php/jchimp/article/view/17814/pdf_1

The goal of this study was to assess the overtreatment of asymptomatic bacteriuria (ASB) in hospitalized patients, calculate the total costs of inappropriate treatment, and determine if a multi-faceted educational intervention was effective in reducing the overtreatment of ASB in a resource-limited community hospital. The study encompassed three phases: a retrospective pre-intervention assessment of the baseline cost and treatment of ASB, the implementation of a multi-faceted educational intervention, and a prospective post-intervention assessment of the efficacy of the intervention. A positive urine culture was defined by bacterial counts ≥105 cfu/mL. In the pre-intervention group, 64 (83%) of 109 patients were asymptomatic: 30 (47%) were treated. In the post-intervention group, 13 (17%) of 55 patients were asymptomatic: 2 (15%) were treated, (p=0.04). Fewer urine cultures were collected during the post-intervention period than the pre-intervention period (3,127 and 3,419, respectively) (p<0.001). The total cost of inappropriately treating ASB in the pre-intervention group was $1200 compared to $600 in the post-intervention group. The results demonstrated a significant decrease in the inappropriate treatment of ASB and the associated costs.