Determining appropriateness of treatment by evaluating providers' documentation of UTI symptoms

Asymptomatic bacteriuria (ASB) is a positive urine culture (UCX) without urinary symptoms. ASB treatment is discouraged due to clinical ineffectiveness and increased risk of antimicrobial resistance. This retrospective cohort determined the prevalence of inappropriate ASB prescribing.

Eligible patients included those seen at any Department of Veterans Affairs outpatient clinic with a positive UCX from January 1, 2019, to December 31, 2022. Visits were placed into 3 categories based on documentation of urinary tract infection (UTI)-specific symptoms: UTI-present, UTI-unlikely, and UTI-absent. Provider reasoning for antibiotic prescriptions was assessed for UTI-unlikely and UTI-absent visits. The time between the visit and prescription dates was also evaluated.

A total of 484 visits were analyzed. There were 258 (53%) UTI-present visits, 113 (23%) UTI-unlikely visits, and 113 (23%) UTI-absent. Two-thirds of the UTI-absent visits and 58% of the UTI-unlikely visits resulted in antibiotic prescriptions. Over one-third (37.6%) of the prescriptions in UTI-absent visits and 27% in UTI-unlikely visits were in response to the urinalysis or UCX results. Most prescriptions given before the visit or more than 9 days after were inappropriate.

In outpatient clinics, most inappropriate antibiotics resulted from providers reacting to laboratory test results. This emphasizes the need for increased ASB diagnostic and antimicrobial stewardship.