Prevalence and treatment of asymptomatic bacteriuria at academic and critical-access hospitals—Opportunities for stewardship efforts

Abstract

Asymptomatic bacteriuria (ASB) is common among hospitalized patients and often leads to inappropriate antimicrobial use. Data from critical-access hospitals are underrepresented. To target antimicrobial stewardship efforts, we measured the point prevalence of ASB and detected a high frequency of ASB overtreatment across academic, community, and critical-access hospitals.

Asymptomatic bacteriuria in critical-access hospitals: Prevalence and patient characteristics driving treatment

“…Although the prevalence of ASB is notably lower in our study compared to previous reports (45%-71%), 75% of patients were inappropriately prescribed antibiotics for ASB. 3,6,7 This finding is consistent with other studies that also reported a high rate of overtreatment. 3,[6][7][8] Although a growing body of evidence demonstrates the lack of clinical benefit with treatment of ASB, more concerning are the underrecognized data suggesting potential harm.…”

“…3,6,7 This finding is consistent with other studies that also reported a high rate of overtreatment. 3,[6][7][8] Although a growing body of evidence demonstrates the lack of clinical benefit with treatment of ASB, more concerning are the underrecognized data suggesting potential harm. 2 Curren et al 9 found that each day of antibiotic therapy was associated with 4% increased odds of experiencing an adverse drug event (ADE).…”

“…10 Even for those patients with ASB who are inappropriately treated, the potential for antibiotic-associated harm could be reduced through decreased duration of therapy. 3,9,10 In our study, most urine cultures was collected in the EDs of CAHs. Thus, EDs represent a high-yield location for stewardship interventions because urine culture is often ordered before initiating a symptom-driven workup as a triage to optimize ED throughput.…”

“… 10 Even for those patients with ASB who are inappropriately treated, the potential for antibiotic-associated harm could be reduced through decreased duration of therapy. 3 , 9 , 10 …”

“…A positive urine culture was defined as 1 or more species of bacteria growing in the urine at ≥100,000 colony-forming units (CFU)/mL. ASB was defined as a positive urine culture without any documented signs or symptoms of UTI, according to the National Hospital Safety Network (NHSN) definition and Infectious Diseases Society of America (IDSA) guidelines: temperature > 38.0°C, suprapubic tenderness, costovertebral angle pain or tenderness, urinary urgency or frequency, dysuria, hematuria, and altered mental status plus a systemic sign of possible infection (peripheral leukocytosis >10,000 cells/mm 3 , systolic blood pressure <90 mmHg, or ≥2 criteria for systemic inflammatory response syndrome [SIRS]). 2 , 5 Patients who were pregnant, who were receiving antimicrobials for a concomitant bacterial infection, or for whom relevant details were missing during data collection were excluded.…”