reducing overtreatment of asymptomatic bacteriuria

WHY: Urinary tract infections are among the top three diagnostic categories driving antibiotic use in the United States, and the estimated rate of overtreatment of asymptomatic bacteriuria (ASB) is 30- 60%. The harms of unnecessary antimicrobial use are well documented and include antibiotic-associated diarrhea, resistance of microorganisms, adverse drug reactions, and increased health care costs. Choosing Wisely initiatives from numerous professional societies have identified treatment of ASB as low value care, and it is an area of focus for the Michigan Hospital Medicine Safety Consortium (HMS).

WHAT: Implement a systems-based plan to reduce both overdiagnosis and overtreatment of asymptomatic bacteriuria. Project goals are to support appropriate antimicrobial stewardship, decrease inappropriate treatment of asymptomatic bacteriuria, standardize laboratory and catheter policies, and improve lab stewardship.

HOW: Multimodal approach to include three components:

• Education (HVC web site info, posters, pocket cards)
• Audit and feedback (HVC teams, attending physicians, ID specialists)
• Clinical decision support algorithm:
  • Clinician required to indicate symptoms of UTI; OR
  • Clinician required to indicate high risk patient category (pregnant, pediatric, urologic/nephrology, immunosuppressed (ANC <1000), bone marrow transplant)
  • Lab performs reflex urine culture if >10 WBC/HPF (most sensitive/specific marker for UTI when including clinical criteria)