Decreasing Antibiotic Resistance through Implementation of Evidence-Based Algorithms for Appropriate Management of Asymptomatic Bacteriuria (ASB) in an Acute Care Setting: A Quality Improvement Project
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Authors
Cook, Jennifer
Issue Date
2020-05-16
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Abstract
Purpose: The purpose of this quality improvement project is to decrease the inappropriate management of asymptomatic bacteriuria in hospitalized patients through provider and nurse education.|Background: Providers are unnecessarily prescribing antibiotics for asymptomatic bacteriuria (ASB). Inappropriate antibiotic management of ASB poses a great risk of further complications and attributes to the increasing rate of antibiotic resistance and healthcare costs.|Setting/Sample: A convenience sample was obtained from the 5th floor general medicine unit of CHI Health Saint Elizabeth's in Lincoln, Nebraska. The sample included those 18 and older, nonpregnant, no urinary catheter, no urostomy, and no upcoming urology procedure.|Methods: A retrospective chart review was performed on data collected 8-weeks pre-education and 8-week post-education using ICD 10 coding specific for Urinary Tract Infections (N39.0). Data was analyzed for documented signs and symptoms associated with urinary tract infections, patients treated with antibiotics for asymptomatic bacteriuria, and the cost of antibiotic treatment associated with inappropriate management.|Results: A decrease in UTI diagnosis from pre-education (n=24) to post-education (n=14) was observed. Of those diagnosed with UTI, 83% were female pre-education and only 50% were female post-education, with an average age not differing much from 68 to 69 years old. Of those started on antibiotics, only 25% pre-education had urinary signs and symptoms compared to 36% post education. Patients with no urinary signs and symptoms had an average of 6 antibiotic days both pre and post education.|Conclusion: The results of this study demonstrate a potential positive correlation between provider education and appropriate management of ASB. Additional studies are needed with an expanded time frame pre and post education to further support this finding. There is a relevant need for consistent ASB guideline adherence to help reduce healthcare costs and antibiotic resistance.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University