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235. If Symptoms Aren’t Described, Antibiotics Aren’t Prescribed: Implementation of a Multifaceted Toolkit Targeting Overtreatment of Asymptomatic Bacteriuria across a Large Health-system

BACKGROUND: Overtreatment of asymptomatic bacteriuria (ASB) is a major challenge for antimicrobial stewardship (ASP). A February 2017 review of our health-system showed >50% of inpatients with a positive urine culture (PUC) were treated despite no urinary tract infection (UTI) symptoms or compell...

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Autores principales: Williamson, Julie E, Logan, Andrea Y, Boger, M Sean, Jarrett, Steven, Irausquin, Stephanie J, Davidson, Lisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253692/
http://dx.doi.org/10.1093/ofid/ofy210.246
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author Williamson, Julie E
Logan, Andrea Y
Boger, M Sean
Jarrett, Steven
Irausquin, Stephanie J
Davidson, Lisa
author_facet Williamson, Julie E
Logan, Andrea Y
Boger, M Sean
Jarrett, Steven
Irausquin, Stephanie J
Davidson, Lisa
author_sort Williamson, Julie E
collection PubMed
description BACKGROUND: Overtreatment of asymptomatic bacteriuria (ASB) is a major challenge for antimicrobial stewardship (ASP). A February 2017 review of our health-system showed >50% of inpatients with a positive urine culture (PUC) were treated despite no urinary tract infection (UTI) symptoms or compelling indications (CI) [pregnancy or pending urologic procedure]. In Fall 2017, we piloted a multifaceted toolkit (MTK) to support an ASB educational campaign (EC) at 26 hospitals. METHODS: A MTK of flyers, a urinary testing algorithm, and narrated slides (Figure 1) was distributed in Fall 2017 and implementation was customized by each hospital’s ASP. Impact of EC on treatment of patients with no urinary symptoms (NUS) or altered mental status (AMS) alone were assessed retrospectively by sampling inpatient PUCs from February 1–28, 2018 in a manner identical to a pre-EC sample. Patients were excluded if: CI, age <18 years, neutropenic, or admitted on UTI therapy or with nephrolithiasis. Demographic, clinical, and laboratory data; UTI symptoms; microbiology results; and antimicrobial therapy received, were collected via an adapted CDC UTI assessment form. Each hospital was surveyed on MTK implementation. RESULTS: Preliminary pre- and post-EC data from the same 14 hospitals are shown. Patients with NUS decreased slightly post-EC, while those with ≥1-specific symptom increased. Treatment of those with NUS declined post-EC, and those with AMS alone received less empiric therapy. Twelve hospitals (86%) completed the MTK survey. Six used all components, five some, and one none. Those who implemented the MTK cited flyers and slides as most useful and preferred the AMS flyer. Although available, only 55% of hospitals affirmed provider algorithm use. CONCLUSION: Post-EC, less patients with a PUC: had NUS, those with NUS were less likely to be treated, and those with AMS alone received less empiric therapy. MTK implementation appeared to impact ASB treatment, and perhaps, testing. Lower use of the testing algorithm may signal a need for simplification. More data are needed to identify which component(s) of the MTK are most effective. DISCLOSURES: L. Davidson, Duke Endowment: Grant Investigator, Grant recipient
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spelling pubmed-62536922018-11-28 235. If Symptoms Aren’t Described, Antibiotics Aren’t Prescribed: Implementation of a Multifaceted Toolkit Targeting Overtreatment of Asymptomatic Bacteriuria across a Large Health-system Williamson, Julie E Logan, Andrea Y Boger, M Sean Jarrett, Steven Irausquin, Stephanie J Davidson, Lisa Open Forum Infect Dis Abstracts BACKGROUND: Overtreatment of asymptomatic bacteriuria (ASB) is a major challenge for antimicrobial stewardship (ASP). A February 2017 review of our health-system showed >50% of inpatients with a positive urine culture (PUC) were treated despite no urinary tract infection (UTI) symptoms or compelling indications (CI) [pregnancy or pending urologic procedure]. In Fall 2017, we piloted a multifaceted toolkit (MTK) to support an ASB educational campaign (EC) at 26 hospitals. METHODS: A MTK of flyers, a urinary testing algorithm, and narrated slides (Figure 1) was distributed in Fall 2017 and implementation was customized by each hospital’s ASP. Impact of EC on treatment of patients with no urinary symptoms (NUS) or altered mental status (AMS) alone were assessed retrospectively by sampling inpatient PUCs from February 1–28, 2018 in a manner identical to a pre-EC sample. Patients were excluded if: CI, age <18 years, neutropenic, or admitted on UTI therapy or with nephrolithiasis. Demographic, clinical, and laboratory data; UTI symptoms; microbiology results; and antimicrobial therapy received, were collected via an adapted CDC UTI assessment form. Each hospital was surveyed on MTK implementation. RESULTS: Preliminary pre- and post-EC data from the same 14 hospitals are shown. Patients with NUS decreased slightly post-EC, while those with ≥1-specific symptom increased. Treatment of those with NUS declined post-EC, and those with AMS alone received less empiric therapy. Twelve hospitals (86%) completed the MTK survey. Six used all components, five some, and one none. Those who implemented the MTK cited flyers and slides as most useful and preferred the AMS flyer. Although available, only 55% of hospitals affirmed provider algorithm use. CONCLUSION: Post-EC, less patients with a PUC: had NUS, those with NUS were less likely to be treated, and those with AMS alone received less empiric therapy. MTK implementation appeared to impact ASB treatment, and perhaps, testing. Lower use of the testing algorithm may signal a need for simplification. More data are needed to identify which component(s) of the MTK are most effective. DISCLOSURES: L. Davidson, Duke Endowment: Grant Investigator, Grant recipient Oxford University Press 2018-11-26 /pmc/articles/PMC6253692/ http://dx.doi.org/10.1093/ofid/ofy210.246 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Williamson, Julie E
Logan, Andrea Y
Boger, M Sean
Jarrett, Steven
Irausquin, Stephanie J
Davidson, Lisa
235. If Symptoms Aren’t Described, Antibiotics Aren’t Prescribed: Implementation of a Multifaceted Toolkit Targeting Overtreatment of Asymptomatic Bacteriuria across a Large Health-system
title 235. If Symptoms Aren’t Described, Antibiotics Aren’t Prescribed: Implementation of a Multifaceted Toolkit Targeting Overtreatment of Asymptomatic Bacteriuria across a Large Health-system
title_full 235. If Symptoms Aren’t Described, Antibiotics Aren’t Prescribed: Implementation of a Multifaceted Toolkit Targeting Overtreatment of Asymptomatic Bacteriuria across a Large Health-system
title_fullStr 235. If Symptoms Aren’t Described, Antibiotics Aren’t Prescribed: Implementation of a Multifaceted Toolkit Targeting Overtreatment of Asymptomatic Bacteriuria across a Large Health-system
title_full_unstemmed 235. If Symptoms Aren’t Described, Antibiotics Aren’t Prescribed: Implementation of a Multifaceted Toolkit Targeting Overtreatment of Asymptomatic Bacteriuria across a Large Health-system
title_short 235. If Symptoms Aren’t Described, Antibiotics Aren’t Prescribed: Implementation of a Multifaceted Toolkit Targeting Overtreatment of Asymptomatic Bacteriuria across a Large Health-system
title_sort 235. if symptoms aren’t described, antibiotics aren’t prescribed: implementation of a multifaceted toolkit targeting overtreatment of asymptomatic bacteriuria across a large health-system
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253692/
http://dx.doi.org/10.1093/ofid/ofy210.246
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