“Kicking CAUTI” Lowers Antibiotic Use for Asymptomatic Bacteriuria

An “antimicrobial stewardship” program can reduce antibiotic overuse in patients with asymptomatic bacteriuria (ASB) related to urinary catheters, according to a study in JAMA Internal Medicine.

The researchers developed the “Kicking CAUTI” intervention as a new approach targeting inappropriate treatment of ASB. The program focused on the reduction of urine culture ordering, with elements that included a case-based audit and streamlined diagnostic algorithm. Preintervention and postintervention comparisons were carried out at two Veterans Affairs health care systems, including patients with urinary catheters on acute medical and long-term care units. The main outcomes were urine cultures ordered and antibiotic prescriptions for patients with ASB—defined as positive urine culture with no signs or symptoms.

During the intervention period, urine culture ordering decreased from 41.2 to 23.3 per 1000 bed-days: incidence rate ratio (IRR) 0.57. During a subsequent maintenance period, there was a further reduction to 12.0 per 1000 bed-days: IRR 0.29. The rate of ASB overtreatment decreased from 1.6 to 0.6 per 1000 bed-days, IRR 0.35, and then to 0.4 per 1000 bed-days, IRR 0.23.

Comparison of sites showed no change in either outcome. The intervention effect on ASB overtreatment was significant on long-term care wards.

The challenges of differentiating ASB from catheter-associated urinary tract infection can lead to overtreatment of asymptomatic patients with positive cultures. The guidelines-based Kicking CAUTI intervention led to sustainable improvements in antimicrobial overuse for ASB without reducing appropriate treatment. Long-term care may be “an emerging domain for antimicrobial stewardship,” the researchers write [Trautner BW, et al. Effectiveness of an antimicrobial stewardship approach for urinary catheter associated asymptomatic bacteriuria. JAMA Intern Med 2015; doi:10.1001/jamainternmed.2015.1878].