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Impact of Diagnostic Stewardship on Urine Culture Ordering in Saudi Arabia: Prospective Pre- and Postintervention
Ahlam Alghamdi1, Afrah Alkazemi2, Alnada Ibrahim1
1Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia, 966 0118239313.
Background:
Inappropriate testing of urine cultures can lead to overuse of antibiotics, antimicrobial resistance, Clostridioides difficile infections, and increased cost. In Saudi Arabia, antimicrobial stewardship programs have improved antibiotic use but lack focus on asymptomatic bacteriuria. Targeted interventions are needed to address this gap.
Objective:
We assessed the implementation of a clinical decision support (CDS) tool in diagnostic stewardship, focusing on the appropriateness of urine culture orders and antibiotic use.
Methods:
We examined differences in urine culture testing and antibiotic use before and after implementation of a CDS tool in a 400-bed hospital in Riyadh, Saudi Arabia, from August 2021 to July 2022. We included adult patients with urine culture orders. Our outcomes were the percentage of urine cultures ordered that were inappropriate and antibiotic use after the implementation of the CDS intervention. We used a multivariable logistic regression model to determine factors associated with inappropriate urine culture testing and antibiotic use.
Results:
The percentage of inappropriate urine culture orders were significantly lower in the postintervention period compared to the preintervention period (821/2254, 36.4% vs 754/1814, 41.6%; P=.001). The CDS intervention was associated with 16.7% lower odds of inappropriate urine culture ordering (adjusted odds ratio [aOR] 0.83, 95% CI 0.73-0.95; P=.008). Unnecessary antibiotics were significantly lower in the postintervention period (310/2254, 72.9% vs 288/1814, 85.7%; P<.001). The CDS intervention was associated with a 52% reduction in unnecessary antibiotic use (aOR 0.487, 95% CL 0.332-0.713; P<.001).
Conclusions:
A CDS initiative can reduce unnecessary urine culture testing and antibiotic overuse.
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