Clinical Trial: Asymptomatic Bacteriuria Guideline Implementation Study

Study Status: Completed
Recruit Status: Completed
Study Type: Interventional

Official Title: Guideline Implementation to Decrease Inappropriate Bacteriuria Treatment

Brief Summary: Overtreatment of asymptomatic bacteriuria (ABU) is a quality, safety, and cost issue, particularly as unnecessary antibiotics lead to emergence of resistant pathogens. Our proposal to bring clinical practice in line with published guidelines has significant potential to reduce unnecessary antibiotic use for ABU in the VA healthcare system, thus improving the quality and safety of veterans' healthcare. Our study will also provide important insights about how to implement and sustain evidence-based clinical practice within VA hospitals.

Detailed Summary:

Anticipated Impacts on Veterans' Healthcare: Urinary tract infection (UTI) is the single most common hospital-acquired infection. However, the majority of cases of nosocomial catheter-associated urinary tract infection (CAUTI) are really asymptomatic bacteriuria (ABU). ABU is not a clinically significant condition, and treatment is unlikely to confer benefit. Overtreatment of ABU is a quality, safety, and cost issue, particularly as unnecessary antibiotics lead to emergence of resistant flora. Our proposal to bring clinical practice in line with published guidelines has significant potential to decrease CAUTI and associated inappropriate antibiotic use in VA hospitals. Our study will also provide information about how to maximize effectiveness of audit-feedback to achieve guideline adherence in the inpatient VA setting.

Project Background/Rationale: Evidence-based guidelines recommend that providers neither screen for nor treat ABU in most catheterized patients. However, a significant gap between these guidelines and clinical practice has been documented at our VA hospital and throughout the world. Since many VA patients in both acute care settings and sub-acute care settings, such as intermediate and long-term care, have a legitimate need for a urinary catheter, the issue of overtreatment of catheter-associated ABU is an active problem for the VA.

Project Objectives: We hypothesize that implementing the existing evidence-based guidelines about non-treatment of ABU will dramatically reduce the unnecessary use of antibiotics to treat ABU and the incidence of incorrectly diagnosed CAUTI. Our first objective is to improve quality of care concerning ABU in terms of specific clinical outcomes (inappropriate screening for and treatment of ABU) through implementation of an audit-feedback strategy. We also hypothesize that success
Sponsor: VA Office of Research and Development

Current Primary Outcome:

  • Number of Cases of ABU That Are Treated Inappropriately With Antibiotics [ Time Frame: Years 1, 2, & 3 ]
  • Urine Cultures Ordered [ Time Frame: three years ]
    Number of urine cultures collected per 1000 catheter-days for each unit
  • Number of Cases of CAUTI Inappropriately Under-treated (no Antibiotics Given) [ Time Frame: Years 1, 2, & 3 ]


Original Primary Outcome: Number of Cases of ABU That Are Treated Inappropriately With Antibiotics [ Time Frame: one year ]

Current Secondary Outcome:

  • Number of Days Antibiotics Are Given to Treat ABU [ Time Frame: one year ]
  • Clinicians' Awareness of and Familiarity With the ABU Guidelines. [ Time Frame: one year ]
  • Clinicians Acceptance of and Outcome Expectancy From Following the ABU Guidelines [ Time Frame: one year ]
  • Number of Catheter-days of Use Per 1000 Patient Bed Days on Each Unit [ Time Frame: One year ]
  • Patient Level Analysis of Inappropriate Antibiotic Use [ Time Frame: three years ]
    We looked at the percentage of cases of ASB (asymptomatic bacteriuria) that were inappropriately over-treated with antibiotics, and we also looked at the percentage of cases of CAUTI (catheter-associated UTI) that were not treated with antibiotics (under-treated).


Original Secondary Outcome:

  • Number of Days Antibiotics Are Given to Treat ABU [ Time Frame: one year ]
  • Clinicians' Awareness of and Familiarity With the ABU Guidelines. [ Time Frame: one year ]
  • Clinicians Acceptance of and Outcome Expectancy From Following the ABU Guidelines [ Time Frame: one year ]
  • Number of catheter-days of use per 100 patient bed days on each unit [ Time Frame: One year ]
  • Number of urine cultures collected per 100 catheter-days for each unit [ Time Frame: One year ]


Information By: VA Office of Research and Development

Dates:
Date Received: January 15, 2010
Date Started: July 2011
Date Completion:
Last Updated: April 17, 2015
Last Verified: April 2015