Evaluation of asymptomatic bacteruria management before and after antimicrobial stewardship program implementation:...

Area of Science:

• Infectious Diseases
• Clinical Pharmacy
• Antimicrobial Resistance

Background:

• Asymptomatic bacteriuria (ASB) is common, but screening and treatment are generally not recommended by guidelines like the Infectious Diseases Society of America (IDSA).
• Inappropriate antibiotic use for ASB contributes to antimicrobial resistance and adverse patient outcomes.
• Evaluating the impact of Antimicrobial Stewardship Programs (ASPs) on ASB treatment is crucial for optimizing antibiotic use.

Purpose of the Study:

• To assess the rate of inappropriate antibiotic prescribing for ASB before and after the implementation of an ASP.
• To identify patterns of antibiotic use and resistance in patients with ASB.
• To inform strategies for reducing unnecessary antibiotic treatment in ASB.

Main Methods:

• Retrospective study of hospitalized patients aged 18 years or older with ASB between 2016 and 2019.
• Exclusion criteria included pregnancy, solid organ transplant, active chemotherapy, and planned urological surgery.
• Analysis of antibiotic prescribing patterns and microbial resistance before and after ASP implementation.

Main Results:

• A high rate of inappropriate antibiotic use (95%) was observed in patients with ASB.
• ASP implementation led to a significant reduction in carbapenem use (P=0.04) and an increase in cephalosporin use (P=0.01).
• Gram-negative bacteria predominated (90%), with 38.7% being multidrug-resistant strains, highlighting the challenge of overtreatment.

Conclusions:

• High rates of inappropriate antibiotic use for ASB persist, even with ASPs.
• Targeting ordering physicians and implementing organizational interventions are essential for reducing overtreatment of ASB.
• Further focus on physician education and awareness is needed to align practice with ASB guidelines.