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The clinical impact of a urinary tract infection management bundle in a tertiary-care teaching hospital

  • Timothy D. MacLaggan (a1), Christopher P. Le (a2), Kristen A. Iverson (a3), Chelsey L. Ellis (a4), Jacques Allard (a5), Tammie J. Wilcox-Carrier (a4) and Daniel J. Smyth (a6)...



The aim of this study was to assess the impact of a urinary tract infection (UTI) management bundle to reduce the treatment of asymptomatic bacteriuria (AB) and to improve the management of symptomatic UTIs.


Before-and-after intervention study.


Tertiary-care hospital.


Consecutive sample of inpatients with positive single or mixed-predominant urine cultures collected and reported while admitted to the hospital.


The UTI management bundle consisted of nursing and prescriber education, modification of the reporting of positive urine cultures, and pharmacists’ prospective audit and feedback. A retrospective chart review of consecutive inpatients with positive urinary cultures was performed before and after implementation of the management bundle.


Prior to the implementation of the management bundle, 276 patients were eligible criteria for chart review. Of these 276 patients, 165 (59·8%) were found to have AB; of these 165 patients with AB, 111 (67·3%) were treated with antimicrobials. Moreover, 268 patients met eligibility criteria for postintervention review. Of these 268, 133 patients (49·6%) were found to have AB; of these 133 with AB, 22 (16·5%) were treated with antimicrobials. Thus, a 75·5% reduction of AB treatment was achieved. Educational components of the bundle resulted in a substantial decrease in nonphysician-directed urine sample submission. Adherence to a UTI management algorithm improved substantially in the intervention period, with a notable decrease in fluoroquinolone prescription for empiric UTI treatment.


A UTI management bundle resulted in a dramatic improvement in the management of urinary tract infection, particularly a reduction in the treatment of AB and improved management of symptomatic UTI.


Corresponding author

Author for correspondence: Dr Timothy MacLaggan, Clinical Resource Pharmacist, Infectious Disease, Horizon Health Network, 135 MacBeath Ave., Suite 6400, Moncton, NB, E1C 6Z8. E-mail: Or Dr Daniel Smyth, Infectious Diseases/Internal Medicine, Horizon Health Network, 135 MacBeath Ave, Suite 6400, Moncton, NB, E1C 6Z8. E-mail:


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PREVIOUS PRESENTATION: Preliminary abstract was presented as a poster for the 2016 AMMI Canada Annual conference and was published as Smyth D, Iverson K, Le C, Hussain Z, MacLaggin T, Wilcox T, Ellis C. The clinical impact of a UTI management bundle in a tertiary-care teaching hospital. JAMMI 2016;1.1:73 (IP13).

Cite this article: MacLaggan TD, et al. (2019). The clinical impact of a urinary tract infection management bundle in a tertiary-care teaching hospital. Infection Control & Hospital Epidemiology 2019, 40, 72–78. doi: 10.1017/ice.2018.276



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1. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309332.
2. Nicolle, LE, Bradley, S, Colgan, R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643654.
3. Cai, T, Mazzoli, S, Mondaini, N, et al. The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: To treat or not to treat? Clin Infect Dis 2012;55:771777.
4. Lin, E, Bhusal, Y, Horwitz, D, et al. Overtreatment of enterococcal bacteriuria. Arch Intern Med 2012;172:3338.
5. Silver, SA, Baillie, L, Simor, AE. Positive urine cultures: a major cause of inappropriate antimicrobial use in hospitals? Can J Infect Dis Med Microbiol 2009;20:107111.
6. Owens, RC Jr, Donskey, CJ, Gaynes, RP, et al. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis 2008;46 Suppl 1:S19S31.
7. Piacenti, FJ, Leuthner, KD. Antimicrobial stewardship and Clostridium difficile-associated diarrhea. J Pharm Pract 2013;26:506513.
8. Dellit, TH, Owens, RC, McGowan, JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159177.
9. Leis, JA, Rebick, GW, Daneman, N, et al. Reducing antimicrobial therapy for asymptomatic bacteriuria among noncatheterized inpatients: a proof-of-concept study. Clin Infect Dis 2014;58:980983.
10. Landry, E, Sulz, L, Bell, A, et al. Urinary Tract Infections: Leading Initiatives in Selecting Empiric Outpatient Treatment (UTILISE). Can J Hosp Pharm 2014;67:116125.
11. Gupta, K, Hooton, TM, Naber, KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:e103e120.
12. Hooton, TM, Bradley, SF, Cardenas, DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010;50:625663.
13. CDC/NHSN surveillance definitions for specific types of infections. Centers for Disease Control and Prevention website. Updated January 2018. Accessed October 15, 2018.
14. Ellis, C SD, MacLaggan, T, Wilcox-Carrier, T, Hussain, Z. Impact of a urinary tract infection management bundle on microbiology workload. JAMMI 2016;1.1:97.
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