Major article
Overtreatment of asymptomatic bacteriuria: Identifying provider barriers to evidence-based care

https://doi.org/10.1016/j.ajic.2014.02.003Get rights and content

Background

Inappropriate use of antibiotics to treat asymptomatic bacteriuria (ASB) is a significant contributor to antibiotic overuse in hospitalized patients despite evidence-based guidelines on ASB management. We surveyed whether accurate knowledge of how to manage catheter-associated urine cultures was associated with level of training, familiarity with ASB guidelines, and various cognitive-behavioral constructs.

Methods

We used a survey to measure respondents' knowledge of how to manage catheter-associated bacteriuria, familiarity with the content of the relevant Infectious Diseases Society of America guidelines, and cognitive-behavioral constructs. The survey was administered to 169 residents and staff providers.

Results

The mean knowledge score was 57.5%, or slightly over one-half of the questions answered correctly. The overall knowledge score improved significantly with level of training (P < .0001). Only 42% of respondents reported greater than minimal recall of ASB guideline contents. Self-efficacy, behavior, risk perceptions, social norms, and guideline familiarity were individually correlated with knowledge score (P < .01). In multivariable analysis, behavior, risk perception, and year of training were correlated with knowledge score (P < .05).

Conclusions

Knowledge of how to manage catheter-associated bacteriuria according to evidence-based guidelines increases with experience. Addressing both knowledge gaps and relevant cognitive biases early in training may decrease the inappropriate use of antibiotics to treat ASB.

Section snippets

Setting and participants

The ASB survey was administered on paper in group settings at an academically affiliated tertiary care medical center between June and September 2011. The hospital had 375 acute care beds and 120 extended care beds, the latter including nursing home beds, skilled nursing care beds, and hospice beds. The targeted participants were the health care providers who make decisions regarding ordering and treating urine cultures. The study was approved by the hospital's Institutional Review Board.

Survey design

No

Respondent characteristics

We received a total of 169 completed surveys from residents and staff clinicians. Of the 188 residents eligible to participate in the survey (ie, in an internal medicine rotation at our hospital during the survey time period), we received 154 (82%) completed surveys, 116 from internal medicine and medicine-pediatrics residents. We also received surveys from 38 non-medicine residents who were on a medicine rotation at the time of the survey; 36 (95%) of these nonmedicine residents were in

Discussion

We performed a survey at an academic teaching hospital among health care providers who make decisions about managing urine culture results on the acute medical care wards and extended care units. Knowledge of evidence-based guidelines was poor among resident physicians, with a mean score only slightly over 50%. However, the faculty and staff providers also demonstrated room for improvement, with a mean knowledge score only 71.4%. We probed the factors that contribute to this lack of knowledge

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  • Cited by (0)

    This work was supported by grants from the Department of Veterans Affairs (VA RR&D Career Development Award B4623 and VA HSR&D IIR 09-104) and the National Institutes of Health (DK092293) to B.W.T. This manuscript is the result of work supported with resources and the use of facilities at the Center for Innovations in Quality, Effectiveness, and Safety (CIN13-413) at the Michael E. DeBakey VA Medical Center, Houston, TX. The opinions expressed reflect those of the authors and not necessarily those of the Department of Veterans Affairs, the US government, the National Institutes of Health, or Baylor College of Medicine. The National Institutes of Health had no role in the design and conduct of the study; the collection, management, analysis and interpretation of the data; or the preparation, review, or approval of the manuscript.

    Conflict of interest: None to report.

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