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Evaluating a Hospitalist-Based Intervention to Decrease Unnecessary Antimicrobial Use in Patients With Asymptomatic Bacteriuria

  • Sarah E. Hartley (a1) (a2), Latoya Kuhn (a2) (a3), Staci Valley (a1), Laraine L. Washer (a1) (a4), Tejal Gandhi (a1), Jennifer Meddings (a1) (a3), Michelle Robida (a5), Salas Sabnis (a5), Carol Chenoweth (a1), Anurag N. Malani (a5), Sanjay Saint (a1) (a2) (a3) and Scott A. Flanders (a1)...

Inappropriate treatment of asymptomatic bacteriuria (ASB) in the hospital setting is common. We sought to evaluate the treatment rate of ASB at the 3 hospitals and assess the impact of a hospitalist-focused improvement intervention.


Prospective, interventional trial.


Two community hospitals and a tertiary-care academic center.


Adult patients with a positive urine culture admitted to hospitalist services were included in this study. Exclusions included pregnancy, intensive care unit admission, history of a major urinary procedure, and actively being treated for a urinary tract infection (UTI) at the time of admission or >48 hours prior to urine collection.


An educational intervention using a pocket card was implemented at all sites followed by a pharmacist-based intervention at the academic center. Medical records of the first 50 eligible patients at each site were reviewed at baseline and after each intervention for signs and symptoms of UTI, microbiological results, antimicrobials used, and duration of treatment for positive urine cultures. Diagnosis of ASB was determined through adjudication by 2 hospitalists and 2 infectious diseases physicians.


Treatment rates of ASB decreased (23.5%; P=.001) after the educational intervention. Reductions in treatment rates for ASB differed by site and were greatest in patients without classic signs and symptoms of UTI (34.1%; P<.001) or urinary catheters (31.2%; P<.001). The pharmacist-based intervention was most effective at reducing ASB treatment rates in catheterized patients.


A hospitalist-focused educational intervention significantly reduced ASB treatment rates. The impact varied across sites and by patient characteristics, suggesting that a tailored approach may be useful.

Infect Control Hosp Epidemiol 2016;37:1044–1051

Corresponding author
Address correspondence to Sarah E. Hartley, MD, Clinical Assistant Professor, University of Michigan Health System, 1500 E Medical Center Drive, SPC 5736, Ann Arbor, MI 48109 (
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PREVIOUS PRESENTATION. Preliminary data were reported as an abstract at the Society of Hospital Medicine Annual Meeting in Las Vegas, Nevada, on March 25, 2014.

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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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