Overtreatment of asymptomatic bacteriuria: identifying provider barriers to evidence-based care

Am J Infect Control. 2014 Jun;42(6):653-8. doi: 10.1016/j.ajic.2014.02.003. Epub 2014 Apr 6.


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.

Keywords: Clinical practice guidelines; Medical education; Urinary catheterization; Urinary tract infection.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Asymptomatic Infections
  • Bacteriuria / drug therapy*
  • Bacteriuria / microbiology
  • Catheter-Related Infections / drug therapy*
  • Catheter-Related Infections / microbiology
  • Clinical Competence
  • Education, Medical
  • Educational Status
  • Evidence-Based Medicine
  • Guideline Adherence
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Inappropriate Prescribing* / psychology
  • Physicians / psychology*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Self Efficacy
  • Social Norms
  • Surveys and Questionnaires
  • Urinary Catheters / adverse effects