Curbing Antibiotic Rx for UTIs in Hospitals

A simple change in how the hospital laboratory reports urine culture results may help improve antibiotic prescribing practices and patient safety, according to a proof-of-concept study conducted in 2013 at Mount Sinai Hospital in Toronto and published online in March 2014 in the journal Clinical Infectious Diseases. The team found that discontinuing the routine reporting of positive urine culture results for inpatients at low risk for urinary tract infections greatly reduced unnecessary antibiotic prescriptions and did not affect the treatment of patients who did need antibiotics.

A release from the Infectious Diseases Society of American reports that urine cultures for hospitalized patients are often ordered unnecessarily. Positive culture results from patients without any UTI symptoms can lead to antibiotic prescriptions that are of no benefit and may cause harm to patients, including C. difficile infection and subsequent infection with more antibiotic-resistant bacteria.

In the study, urine culture results from non-catheterized inpatients—those at lower risk for developing a UTI—were no longer reported automatically to the ordering physician. Instead, a message was posted to the patient's electronic medical record asking caregivers to call the lab for the results only if a UTI was strongly suspected.

The message reminded providers that "the majority of positive urine cultures from inpatients without an indwelling urinary catheter represent asymptomatic bacteriuria," a condition for which current practice guidelines do not usually recommend antibiotics, unless the patient is pregnant or will be undergoing certain urological procedures.

After the change in how the culture results were reported, the rate of antibiotic treatment for asymptomatic bacteriuria among non-catheterized patients decreased from 48 percent to 12 percent. Treatment rates among patients in the catheterized control group—whose culture results were routinely reported as before—remained steady, at 41 percent. Patients with positive culture results were assessed by a study investigator for UTI symptoms within 24 hours. Four UTIs developed among the non-catheterized patients; in all of these cases, clinicians had already started appropriate antibiotic treatment when the urine cultures were ordered, based on the patients' symptoms.