Overtreatment of Asymptomatic Bacteriuria: Identifying Targets for Improvement

Abstract

Treatment of asymptomatic bacteriuria contributes to antimicrobial overuse in hospitalized patients. Indications for urine culture, treatment, and targets for improvement were evaluated in 153 patients. Drivers of antimicrobial overuse included fever with an alternative source, altered mental status, and leukocytosis, which led 435 excess days of antimicrobial therapy.

Urine Culture on Admission Impacts Antibiotic Use and Length of Stay: A Retrospective Cohort Study

“…Positive urine cultures are a powerful behavioral stimulus for treatment with antibiotics regardless of medical appropriateness. 9,10 Our findings provide 2 important contributions to the literature. First, the association of urine culture testing on antibiotic use was greatest for patients admitted through the emergency room.…”

“…Recent studies have demonstrated that 61%-71% of positive urine cultures in hospitalized patients represent asymptomatic bacteriuria. 9,10 Prior literature has routinely demonstrated that hospitalized patients are often inappropriately started and continued on antibiotics in response to false-positive urine cultures. [7][8][9][10] Unnecessary antibiotics have risks, not only for the patients receiving the antibiotics but also for other patients cared for in the same hospital.…”

“…9,10 Prior literature has routinely demonstrated that hospitalized patients are often inappropriately started and continued on antibiotics in response to false-positive urine cultures. [7][8][9][10] Unnecessary antibiotics have risks, not only for the patients receiving the antibiotics but also for other patients cared for in the same hospital. One recent study demonstrated that receipt of antibiotics by prior hospital bed occupants was an independent risk factor for Clostridium difficile infection in subsequent patients occupying the same bed, regardless of whether the initial occupant had Clostridium difficile.…”

“…6,7 Positive urine cultures, even in the absence of symptoms, are strongly linked to subsequent inappropriate antibiotic use in hospitalized patients. [7][8][9][10] Inappropriate antibiotic use contributes to antibiotic resistance and is a threat to public health. [11][12][13] For these reasons, the Choosing Wisely campaign and several national guidelines strongly recommend against urine culture testing in the absence of urinary tract symptoms.…”

“…Prior studies examining the effect of inpatient urine culture testing on antibiotic use have been limited to small samples drawn from a few institutions. [6][7][8][9][10] The aims of this study were to examine the impact of inpatient urine culture testing on inpatient antibiotic use and hospital LOS using a national administrative dataset. To guide development of interventions aimed at reducing unnecessary urine testing, we identified the inpatient medical and surgical diagnoses most impacted by urine culture testing on admission.…”