An Implementation Guide to Reducing Overtreatment of Asymptomatic Bacteriuria

Michael Daniel; Sara Keller; Mohammad Mozafarihashjin; Amit Pahwa; Christine Soong

doi:10.1001/jamainternmed.2017.7290

Special Communication

Less Is More

An Implementation Guide to Reducing Overtreatment of Asymptomatic Bacteriuria

Amit Pahwa, MD^1,6; Christine Soong, MD, MSc^7,8,9

¹Department of Medicine, Johns Hopkins University, Baltimore, Maryland
²Division of Infectious Disease, Johns Hopkins Hospital, Baltimore, Maryland
³Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
⁴Department of Infection Control, Sinai Health System, Toronto, Ontario, Canada
⁵Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
⁶Division of Hospital Medicine, Johns Hopkins Hospital, Baltimore, Maryland
⁷Division of General Internal Medicine, Sinai Health System, Toronto, Ontario, Canada
⁸Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
⁹Centre for Quality and Patient Safety, University of Toronto, Ontario, Canada

Key Points

Question What are the most effective interventions to reduce inappropriate treatment of asymptomatic bacteriuria?

Findings Successful interventions used a multimodal approach combining some elements of education, audit and feedback, withholding routine urine culture reports, clinical decision support, and protocols and algorithms. Efforts to decrease inappropriate treatment of asymptomatic bacteriuria can reduce preventable harm from unnecessary antimicrobial exposure.

Meaning Successful interventions can reduce inappropriate treatment of asymptomatic bacteriuria while improving value and patient safety outcomes.

Abstract

Treatment of asymptomatic bacteriuria (ASB) frequently lacks appropriate indication, yet remains prevalent across settings. Numerous guidelines, professional societies, and campaigns such as Choosing Wisely advocate against this low-value practice. Efforts aimed at reducing unnecessary treatment of ASB demonstrate improved costs, and avoidable harm without increased risk of adverse events. We propose an evidence-based implementation guide to aid practitioners in reducing inappropriate treatment of ASB.

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An Implementation Guide to Reducing Overtreatment of Asymptomatic Bacteriuria

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