Infection Control & Hospital Epidemiology

Original Articles

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

Leslie A. Linaresa1a2, David J. Thorntona1a2, Judith Strymisha2a3, Errol Bakera1 and Kalpana Guptaa1a2 c1

a1 Veterans Affairs Boston Health Care System, Boston, Massachusetts

a2 Boston University School of Medicine, Boston, Massachusetts

a3 Harvard Medical School, Boston, Massachusetts


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.

(Received December 08 2010)

(Accepted January 28 2011)


c1 VA Boston HCS, 1400 VFW Parkway, 111 Med, West Roxbury, MA 02132 (