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Modified Reporting of Positive Urine Cultures to Reduce Inappropriate Treatment of Asymptomatic Bacteriuria Among Nonpregnant, Noncatheterized Inpatients: A Randomized Controlled Trial

Published online by Cambridge University Press:  28 May 2018

Peter Daley ,
David Garcia ,
Raheel Inayatullah ,
Carla Penney  and
Sarah Boyd
Peter Daley*
Affiliation:
Memorial University of Newfoundland Department of Clinical Epidemiology, St John’s, Newfoundland, Canada Memorial University of Newfoundland Department of Medicine, St John’s, Newfoundland, Canada; Canada A1B3V6 ([email protected]).
David Garcia
Affiliation:
Memorial University of Newfoundland Department of Clinical Epidemiology, St John’s, Newfoundland, Canada
Raheel Inayatullah
Affiliation:
Memorial University of Newfoundland Department of Medicine, St John’s, Newfoundland, Canada; Canada A1B3V6 ([email protected]).
Carla Penney
Affiliation:
Memorial University of Newfoundland Department of Clinical Epidemiology, St John’s, Newfoundland, Canada
Sarah Boyd
Affiliation:
Memorial University of Newfoundland Department of Clinical Epidemiology, St John’s, Newfoundland, Canada
*
Address correspondence to Peter Daley, Associate Professor of Medicine, Memorial University of Newfoundland, Room 1J421, 300 Prince Phillip Dr, St John’s, Newfoundland,
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Abstract

DESIGN

We conducted a randomized, parallel, unblinded, superiority trial of a laboratory reporting intervention designed to reduce antibiotic treatment of asymptomatic bacteriuria (ASB).

METHODS

Results of positive urine cultures from 110 consecutive inpatients at 2 urban acute-care hospitals were randomized to standard report (control) or modified report (intervention). The standard report included bacterial count, bacterial identification, and antibiotic susceptibility information including drug dosage and cost. The modified report stated: “This POSITIVE urine culture may represent asymptomatic bacteriuria or urinary tract infection. If urinary tract infection is suspected clinically, please call the microbiology laboratory … for identification and susceptibility results.” We used the following exclusion criteria: age <18 years, pregnancy, presence of an indwelling urinary catheter, samples from patients already on antibiotics, neutropenia, or admission to an intensive care unit. The primary efficacy outcome was the proportion of appropriate antibiotic therapy prescribed.

RESULTS

According to our intention-to-treat (ITT) analysis, the proportion of appropriate treatment (urinary tract infection treated plus ASB not treated) was higher in the modified arm than in the standard arm: 44 of 55 (80.0%) versus 29 of 55 (52.7%), respectively (absolute difference, −27.3%; RR, 0.42; P = .002; number needed to report for benefit, 3.7).

CONCLUSIONS

Modified reporting resulted in a significant reduction in inappropriate antibiotic treatment without an increase in adverse events. Safety should be further assessed in a large effectiveness trial before implementation

TRIAL REGISTRATION. clinicaltrials.gov#NCT02797613

Infect Control Hosp Epidemiol 2018;814–819

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 7 , July 2018 , pp. 814 - 819
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

REFERENCES

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