Implementation of an asymptomatic bacteriuria assessment protocol for patients discharged from the emergency department

Margaret R Hitchins; Jeannette L Bouchard; Christopher W Ingram; Alison I Orvin

doi:10.1017/ash.2023.117

Implementation of an asymptomatic bacteriuria assessment protocol for patients discharged from the emergency department

Antimicrob Steward Healthc Epidemiol. 2023 Feb 27;3(1):e37. doi: 10.1017/ash.2023.117. eCollection 2023.

Authors

Margaret R Hitchins¹, Jeannette L Bouchard^{1

2}, Christopher W Ingram³, Alison I Orvin^{1

2}

Affiliations

¹ Department of Pharmacy, WakeMed Health and Hospitals, Raleigh, North Carolina.
² University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina.
³ Infection Control and Occupational Health, WakeMed Health and Hospitals, Raleigh, North Carolina.

Abstract

Objective: We evaluated the impact of an asymptomatic bacteriuria (ASB) assessment protocol on the number of antibiotics prescribed for ASB after discharge from the emergency department (ED).

Design: Single-center, before-and-after, retrospective cohort study.

Setting: The study was conducted at a large community health system in North Carolina.

Patients: Eligible patients were discharged from an ED without an antibiotic prescription and had a positive urine culture result after discharge from May through July 2021 (preimplementation group) and October through December 2021 (postimplementation group).

Methods: Patient records were reviewed to determine the number of antibiotic prescriptions for ASB on follow-up call before and after implementation of an ASB assessment protocol. Secondary outcomes included 30-day admissions, 30-day ED visits, 30-day UTI-related encounters, and projected antibiotic days of therapy.

Results: The study included 263 patients: 147 in the preimplementation group and 116 in the postimplementation group). There were significantly fewer antibiotic prescriptions for ASB in the postimplementation group (50% vs 87%; P < .0001). There were no differences in the incidence of 30-day admissions (7% vs 8%; P = .9761), 30-day ED visits (14% vs 16%; P = .7805), or 30-day UTI-related encounters (0% vs 0%, NA).

Conclusions: Implementation of an ASB assessment protocol for patients discharged from the ED significantly reduced the number of antibiotic prescriptions for ASB on follow-up call without an increase in 30-day admissions, ED visits, or UTI-related encounters.