Evaluation of asymptomatic bacteruria management before and after antimicrobial stewardship program implementation: retrospective study

BMC Infectious Diseases

Ghaida Alghamdi¹  Isra Alghamdi¹  Amjad Alganame²  Shorooq Alanazi²  Raneem Alalawi²  Salman Alharthi³  Majid Almajid³  Ahlam Alghamdi⁴ 

[1] College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia;College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia;Department of Pharmacy, Security Forces Hospital Program, Riyadh, Saudi Arabia;Pharmacy Practice Department, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia;Pharmacy Practice Department, King Abdullah bin AbdulAziz University Hospital, Riyadh, Saudi Arabia;

关键词: Antimicrobial agent;    Asymptomatic bacteriuria;    Urinary tract infection;    Antimicrobial stewardship program;   

DOI  :  10.1186/s12879-021-06460-6

来源: Springer

【 摘 要 】

BackgroundThe Infectious Diseases Society of America (IDSA) recommends against screening for and/or treating asymptomatic bacteriuria (ASB). This study aims to evaluate the inappropriate use of antibiotics in ASB before and after Antimicrobial Stewardship Program (ASP) implementation and advance towards its appropriate use.MethodWe performed a retrospective study of patients diagnosed with ASB from 2016 to 2019 at a tertiary hospital in Saudi Arabia. This study included hospitalized patients ≥ 18 years old who had a positive urine culture with no documented signs or symptoms of urinary tract infection We excluded pregnant women, solid organ transplant patients, patient on active chemotherapy, and patients about to undergo urological surgery.ResultsA total of 716 patients with a positive urine culture were screened. Among these, we identified 109 patients with ASB who were included in our study. The rate of inappropriate antibiotic use was 95% during the study period. The implementation of the ASP Program was associated with a significant reduction in the use of carbapenems (P = 0.04) and an increase in the use of cephalosporins (P = 0.01). However, overprescribing antimicrobial agents was a concern in both eras. Approximately 90% of the microorganisms identified were gram-negative bacteria. Of those, 38.7% were multidrug-resistant strains.ConclusionThe urine culture order in ASB is considered relatively small number; however, it showed a high rate of the inappropriate use of antibiotics when there is an order of urine culture in both era. ASP ought to focus on targeting the ordering physician, promoting awareness and/or organizational interventions that appear to reduce the incidence of overtreatment.

【 授权许可】

CC BY