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ID
Source
Brief title
Health condition
Asymptomatic bacteriuria is the presence of bacteria in the urine of a patient, who does not have symptoms of urinary tract infection (UTI). This is a common finding especially among women, elderly persons, and patients with urinary catheters. Guidelines strongly recommend not to screen for or treat asymptomatic bacteriuria with antimicrobials, except for specific patients at risk of developing a complicated UTI.
Sponsors and support
Intervention
Outcome measures
Primary outcome
The percentage of patients with ASB without risk factors or other alternative site of infections who are treated with antimicrobials.
Secondary outcome
The duration of antimicrobial treatment for ASB, the number of urine cultures per 1000 patients at the emergency department, the number of urinalysis (dipsticks and microscopic analysis), incorrect treatment of patients with urine cultures that are in daily practice considered positive with a quantitative count of bacteria ≥10^3 CFU/ml, and the percentage of patients treated with antimicrobials for a positive urinalysis without symptoms or risk factors as stated above. In addition, the total number of urine cultures ordered in the hospital will be assessed explorative. Furthermore, the indications for the negative urine cultures will be assessed explorative
during the baseline period.
Background summary
Antimicrobials for asymptomatic bacteriuria (ASB) is one of the most common unnecessary treatments. Earlier studies showed that this inappropriate treatment has a prevalence of 45%. With regard to international guidelines and antimicrobial stewardship, successful multifaceted interventions showed a decrease in overtreatment of ASB. The main objective is to reach a 50% reduction in overtreatment of ASB by using a de-implementation strategy.
We will use a stepped wedge cluster randomized design for our multifaceted de-implementation strategy, comparing outcomes before and after introduction of our intervention in the emergency department of five hospitals (clusters) in the Netherlands. The de-implementation strategy consists of a combination of interventions, such as education, audit and feedback. All patients (≥18 years old) who had a urine test while presented at the emergency department will be screened for eligibility. The primary endpoint is overtreatment of ASB without risk factors (e.g. pregnancy, planned invasive urologic procedures and neutropenia). Secondary endpoints are the duration of antimicrobial treatment for ASB, the number of urine cultures and urinalysis per 1000 patients, and overtreatment of positive urinalysis in asymptomatic patients.
Ethical approval was obtained from Medical Ethics Research Committee of the Academic Medical Centre (Amsterdam, the Netherlands), with a waiver for informed consent. Local feasibility was obtained by the local institutional review boards of all participating hospitals. Our study aims to reduce inappropriate screening and treatment of ASB in emergency departments, improve healthcare quality, lower the increase in antimicrobial resistance, and save costs. If proven (cost)-effective, this study provides a well suited strategy for a nationwide approach to reduce overtreatment of ASB.
Study objective
Our study aims to reduce inappropriate screening and treatment of ASB in emergency departments by 50%, improve healthcare quality, lower the increase in antimicrobial resistance, and save costs.
Study design
We will start the intervention periods every one or two months, depending on how many patients will be included during the first month.
Intervention
A multifaceted de-implementation strategy.
Tessa van Horrik
0205665992
t.m.vanhorrik@amsterdamumc.nl
Tessa van Horrik
0205665992
t.m.vanhorrik@amsterdamumc.nl
Inclusion criteria
Our target size is at least 420 patients.
Patients ≥18 years old who had urine tests (culture and/or urinalysis), that were obtained during presentation at the emergency department will be screened for eligibility.
Exclusion criteria
- Negative urinalysis and negative urine cultures
- Patients with symptomatic UTI
- Patients with an alternate site of infection for which they receive antimicrobial treatment
- Patients with ASB and risk factors, defined as pregnant women, patients prior to planned invasive urologic procedures associated with mucosal trauma (including transurethral surgery of the prostate or bladder, ureteroscopy including lithotripsy, and percutaneous stone surgery), and high-risk neutropenia (defined as absolute neutrophil count <500 cells/µl).
Design
Recruitment
IPD sharing statement
Plan description
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In other registers
| Register | ID |
|---|---|
| NTR-new | NL8242 |
| Other | METC AMC : W19_472 |