Overtreatment of asymptomatic bacteriuria: a qualitative study

Area of Science:

• Medical Research
• Infectious Diseases
• Healthcare Management

Background:

• Overtreatment of asymptomatic bacteriuria (ASB) is common, leading to antibiotic side effects, increased costs, and antimicrobial resistance.
• International guidelines do not recommend antibiotic treatment for ASB, except in specific circumstances.

Purpose of the Study:

• To investigate the underlying reasons why physicians prescribe antibiotics for ASB when there is no clinical indication.
• To identify physician-centered and external factors contributing to unnecessary antibiotic prescriptions.

Main Methods:

• A qualitative study was conducted at a Swiss tertiary care hospital in 2011.
• Semi-structured interviews were performed with 21 internal medicine residents and attending physicians.
• Data analysis involved an inductive thematic content approach using MAXQDA software.

Main Results:

• Physicians frequently treated laboratory findings of ASB without considering the clinical picture (17/21).
• Psychological factors, including anxiety and overcautiousness, influenced treatment decisions (13/21).
• External pressures like institutional culture, peer influence, patient expectations, and workload also contributed (9/21).
• Difficulty interpreting clinical signs and symptoms was reported by some physicians (8/21).

Conclusions:

• Physician-centered factors (e.g., overcautiousness) and external pressures (e.g., workload) motivate unnecessary antibiotic prescribing for ASB.
• The practice of treating ASB based solely on lab results suggests a lack of awareness of evidence-based guidelines.
• Interventions addressing these factors are needed to curb antibiotic overtreatment.