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Treatment bundle leads to ‘dramatic improvement’ in UTI management
A UTI management bundle implemented at a Canadian hospital resulted in a “dramatic improvement” in the management of UTIs, including reducing the treatment of asymptomatic bacteriuria and improving the management of symptomatic infections, researchers said.
Writing in Infection Control & Hospital Epidemiology, Timothy D. MacLaggan, PharmD, a researcher in the Horizon Health Network in Moncton, New Brunswick, and colleagues said most patients do not benefit from the treatment of asymptomatic bacteriuria (AB).
“Despite having no clinical benefit, antimicrobial therapy is frequently provided to patients with AB in an inpatient setting,” MacLaggan and colleagues wrote. “Inappropriate provision of antimicrobial therapy for AB increases the risk of adverse events, including infection with Clostridium difficile.”
The researchers evaluated the use of a UTI management bundle that consisted of nursing and prescriber education, modification of the reporting of positive urine cultures and pharmacists’ prospective audit and feedback. Before and after implementation of the bundle, a retrospective chart review was performed of consecutive inpatients with positive urinary cultures, according to the study.
MacLaggan and colleagues reviewed charts for 276 eligible patients before the UTI management bundle was implemented, and 268 patients were eligible for chart review after the intervention. They found that 59.8% (n = 165) of patients before the management bundle had asymptomatic bacteriuria, compared with 49.6% (n =133) post-intervention. According to the study findings, 67.3% (n = 111) of patients before the intervention were treated with antimicrobials, whereas 16.5% (n = 22) received antimicrobials post-intervention — a 75.5% reduction in the treatment of asymptomatic bacteriuria.
MacLaggan and colleagues observed a substantial decrease in nonphysician-directed urine sample submission associated with educational components of the bundle. They also found that adherence to a UTI management algorithm substantially improved during the intervention period and that the prescriptions of fluoroquinolones for empiric UTI treatment “notably decreased.”
“Our study has shown that the laboratory-based intervention, in both noncatheterized and catheterized patients as part of a UTI management bundle, is effective in reducing the inappropriate treatment of AB and improving overall adherence to best practice,” MacLaggan and colleagues concluded. “Improvements were observed in all three domains assessed as part of the overall adherence to best practice assessment with respect to appropriateness to culture, appropriate antimicrobial use, and appropriate duration of therapy.” – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.