Diagnostic stewardship drives reduction in antibiotic prescribing for UTIs
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WASHINGTON — Decreases in urine cultures for asymptomatic bacteriuria reduced unnecessary antibiotic prescribing for UTIs, according to a study presented at IDWeek.
Researchers sought to determine whether diagnostic stewardship — that is, avoiding unnecessary urine cultures — or antibiotic stewardship was more effective at reducing antibiotic use for asymptomatic bacteriuria (ASB). They conducted a 3-year quality improvement initiative that included both interventions.
“What you see is that there was a substantial and significant decrease over time in a percentage of patients treated for a UTI who actually had asymptomatic bacteriuria — so, diagnostic stewardship really won the day and worked well,” Valerie Vaughn, MD, MSc, director of hospital medicine research at the University of Utah School of Medicine, said in a presentation at IDWeek.
Researchers analyzed data from 14,572 patients treated at 46 Michigan hospitals participating in the Michigan Hospital Medicine Safety Consortium between July 1, 2017, and March 31, 2020 — all of whom had a positive urine culture.
Of these, 4,134 (28.4%) had ASB, and of patients with ASB, 3,175 (76.8%) were treated with antibiotics. Patients were considered to have ASB if they had no signs or documented symptoms of a UTI, said Vaughn, lead author of the study.
After 3 years, the percentage of patients with a positive urine culture who had ASB dropped from 34.1% to 22.5%. The percentage of patients with ASB treated with antibiotics, however, stayed “relatively stable,” declining from 82% to 76.3%, as did the mean antibiotic duration for patients with ASB, which declined to 5.93 days from 6.38 days.
Vaughn said the study was motivated by a curiosity to see which of the stewardship options could best help reduce antibiotic resistance among patients with UTI, which studies have shown is an increasing concern.
“Diagnostic stewardship really wins the day,” she said.
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Vaughn V, et al. Abstract 1592. Presented at IDWeek; Oct. 19-23, 2022; Washington (hybrid meeting).
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