VA intervention linked to better treatment for asymptomatic bacteriuriaAn antibiotic stewardship intervention for asymptomatic bacteriuria (ASB) was associated with a reduction in urine cultures and antibiotic use at four Veterans Affairs (VA) hospitals, researchers reported today in JAMA Network Open.To reduce unnecessary antibiotic treatment for ASB—the presence of bacteria in the urinary tract without related symptoms—clinicians and researchers at four geographically distant VA hospitals implemented the Less is More for ASB project, which encompassed case-based education to train clinicians who order urine cultures and dispense antibiotics how to use an algorithm to distinguish ASB from a urinary tract infection.Previous research by the VA has shown that 72% of ASB patients at 25 VA hospitals received antibiotics unnecessarily.
The program was implemented by a centralized coordinating center that provided coaching and troubleshooting to site champions at each hospital.To assess the effectiveness of the intervention, researchers conducted an interrupted time series study at the four intervention hospitals and four comparison hospitals from October 2017 through April 2020.
The main outcomes were the total number of urine cultures ordered, antibiotic days of therapy (DOT), and length of therapy (LOT).A total of 11,299 patients were included in the study (94.7% men; mean age, 72.6 years).
The decrease in urine cultures before and after the intervention was not significant in the intervention hospitals per segmented regression analysis, but a difference-in-differences analysis comparing intervention with comparison hospitals found that the number of urine cultures ordered fell by 3.24 urine cultures per 1,000 bed-days.In