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

Published online by Cambridge University Press:  02 January 2015

Leslie A. Linares ,
David J. Thornton ,
Judith Strymish ,
Errol Baker  and
Kalpana Gupta
Leslie A. Linares
Affiliation:
Veterans Affairs Boston Health Care System, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
David J. Thornton
Affiliation:
Veterans Affairs Boston Health Care System, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
Judith Strymish
Affiliation:
Boston University School of Medicine, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Errol Baker
Affiliation:
Veterans Affairs Boston Health Care System, Boston, Massachusetts
Kalpana Gupta*
Affiliation:
Veterans Affairs Boston Health Care System, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
*
VA Boston HCS, 1400 VFW Parkway, 111 Med, West Roxbury, MA 02132 (kalpana.gupta@va.gov)
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Abstract

Objectives.

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.

Design, Setting, and Patients.

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.

Intervention.

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.

Methods.

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.

Results.

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.

Conclusions.

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 7 , July 2011 , pp. 644 - 648
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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