MedicalResearch.com Interview with:
Barbara W. Trautner, MD, PhD
Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center
Section of Infectious Diseases
Department of Medicine
Baylor College of Medicine, Houston, Texas
Medical Research: What is the background for this study? What are the main findings?
Dr. Trautner: Reducing antimicrobial overuse, or antimicrobial stewardship, is a national imperative. If we fail to optimize and limit use of these precious resources, we may lose effective antimicrobial therapy in the future. CDC estimates that more than $1 billion is spent on unnecessary antibiotics annually, and that drug-resistant pathogens cause 2 million illnesses and 23,000 deaths in the U.S. each year. The use of antibiotics to treat asymptomatic bacteriuria (ASB) is a significant contributor to antibiotic overuse in hospitalized and nursing home patients, especially among patients with urinary catheters. In catheterized patients, ASB is very often misdiagnosed and treated as catheter-associated urinary tract infection (CAUTI). Therefore, we designed the “Kicking CAUTI: The No Knee-Jerk Antibiotics Campaign intervention” to reduce overtreatment of ASB and to reduce the confusion about distinguishing CAUTI from asymptomatic bacteriuria.
This study evaluated the effectiveness of the Kicking CAUTI intervention in two VAMCs between July 2010 and June 2013. The primary outcomes were urine cultures ordered per 1,000 bed-days (inappropriate screening for ASB) and cases of ASB receiving antibiotics (overtreatment). The study included 289,754 total bed days, with 170,345 at the intervention site and 119,409 at the comparison site. Through this campaign, researchers were able to dramatically decrease the number of urine cultures ordered. At the intervention site, the total number of urine cultures ordered decreased by 71 percent over the course of the intervention. Antibiotic treatment of asymptomatic bacteriuria decreased by more than 75 percent during the study. No significant changes occurred at the comparison site over the same time period. Failure to treat catheter-associated urinary tract infection when indicated did not increase at either site.
Medical Research: What should clinicians and patients take away from your report?
Dr. Trautner: Antibiotic stewardship is every person’s responsibility, patient and providers alike. Providers need to recognize the harms of indiscriminant use of antimicrobials and stop and think before treating a patient for a CAUTI that may or may not exist. Patients likewise can help by recognizing that antibiotics are not any more effective for treating asymptomatic bacteriuria than they are for treating the common cold.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Trautner: Our next step is to implement our intervention in other VA hospitals nation-wide. For this purpose we have joined forces with several VA operational partners to initiate the VA Choosing Wisely Campaign for UTI. The antimicrobial stewardship lessons learned from Kicking CAUTI have also helped inform the antimicrobial stewardship components of the AHRQ Safety Program for Long-Term Care: Preventing CAUTI and Other HAIs, another national project.
Trautner BW, Grigoryan L, Petersen NJ, et al. Effectiveness of an Antimicrobial Stewardship Approach for Urinary Catheter Associated Asymptomatic Bacteriuria. JAMA Intern Med. Published online May 26, 2015. doi:10.1001/jamainternmed.2015.1878.
Barbara W. Trautner, MD, PhD, & Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (2015). No Knee-Jerk Antibiotics Campaign Aims To Reduce Antibiotic Overusage