Urinary Tract Infections Reporting Change Reduced Antibiotic Use

Dr. Jerome A. Leis, MD, MSc Sunnybrook Health Sciences Centre Toronto, ON, M4N 3M5, CanadaMedicalResearch.com Interview with:
Dr. Jerome A. Leis, MD, MSc
Sunnybrook Health Sciences Centre
Toronto, ON, M4N 3M5, Canada
MedicalResearch.com: What are the main findings of the study?

Dr. Leis: We know that positive urine cultures from patients who lack signs and symptoms of urinary tract infection are a trigger FOR unnecessary antibiotic prescriptions in hospitals. This problem has not improved despite many educational initiatives.  We identified a subset of patients in our hospital where only 2% of all urine specimens sent to the laboratory were associated with symptomatic infection and decided to no longer routinely report positive results from these specimens on the electronic medical record, unless a special telephone request was made.  We found that with this simple change, unnecessary antibiotic prescriptions declined markedly and this did not require any education of care providers. Most importantly, based on our safety audits, patients who had a urinary tract infection all received appropriate treatment.


MedicalResearch.com: Were any of the findings unexpected?

Dr. Leis: We wanted to test the hypothesis that the positive results themselves were driving the decision to treat with antibiotics among patients who would not otherwise have been considered to have a urinary tract infection.  Once we asked care providers to call for the results, we received very few requests confirming that they had a low clinical suspicion of urinary tract infection in these patients.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Leis: Unnecessary testing is not only wasteful to the healthcare system, but can also lead to downstream harm to patients.  Urine is the most common specimen to be sent for culture among hospitalized patients, yet we know that the number of urine cultures ordered far exceeds the number of urinary tract infections. These unnecessary urine cultures generate positive results from patients without symptoms of infection and prompt treatment with antibiotics that carry unneeded risk.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Leis: Although promising, this change in laboratory reporting is not ready to become standard practice.  Larger studies in more than one institution are needed to better assess the full impact of this change.

Citation:

Reducing Antimicrobial Therapy for Asymptomatic Bacteriuria
Clin Infect Dis. first published online February 26, 2014 doi:10.1093/cid/ciu010

Jerome A. Leis, Gabriel W. Rebick, Nick Daneman, Wayne L. Gold, Susan M. Poutanen, Pauline Lo, Michael Larocque, Kaveh G. Shojania, and Allison McGeer