reducing overtreatment of asymptomatic bacteriuria
November 14, 2018- An evidence-based algorithm to reduce overdiagnosis and overtreatment of asymptomatic bacteriuria (ASB) has been approved with the input and review of McLaren physician leaders at multiple levels: Asymptomatic Bacteriuria Working Group, Subsidiary HVC Teams, and the HVC Steering Committee.
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)
ASB Project Summary
Choosing Wisely Lists Focusing on ASB
Don’t treat asymptomatic bacteriuria with antibiotics.
Don’t perform urinalysis, urine culture, blood culture or C. difficile testing unless patients have signs or symptoms of infection. Tests can be falsely positive leading to over diagnosis and overtreatment.
Don’t obtain a urine culture unless there are clear signs and symptoms that localize to the urinary tract.
Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.
Avoid the use of surveillance cultures for the screening and treatment of asymptomatic bacteriuria.
Antibiotics have side effects and usually don't help when there are no UTI symptoms.