Influence of a microbiological commentary on the management of asymptomatic bacteriuria

The treatment of asymptomatic bacteriuria (AB) has been associated with increased in antibiotic resistance and Clostridioides difficile infection, without clinical benefit. One strategy to improve management is to incorporate a recommendation in the microbiological report. The aim of the study was to assess the impact of this intervention on antibiotic prescribing for AB.

Potential cases of AB were identified, and the following comment was included in the microbiology report: "Assess according to clinical findings. In AB, no treatment is recommended". Patient demographics, sample characteristics, reason for request, isolated microorganism, resistance profile, time to clinician's review of the report, initiation of treatment and its causes, and repeat urine culture were collected. Factors associated with adherence to the recommendations were evaluated.

A total of 391 possible AB cases were identified. The majority of samples originated, from primary care (96%) and in women over 65 years of age (98%). Antibiotic treatment was initiated in 60% of cases, while the microbiological recommendation was followed in 40%. Factors associated with nonadherence to the recommendation included urine culture request prompted by foul-smelling or cloudy urine, and repeat culture. In contrast, urine cultures requested during routine health checks were more likely to be associate with adherence to the recommendation.

The inclusion of a commentary in the microbiology report contributed to a reduction in antimicrobial prescription in AB. This intervention may be effective in optimising antibiotic prescribing practices and improving urine culture request management policies.