Management of Asymptomatic Bacteriuria and Antibiotic Stewardship at a District General Hospital
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Background
Increasing rates of healthcare-associated infections, particularly Clostridioides difficile , among inpatients in the elderly medicine ward of a local district general hospital highlighted a critical need for enhanced antibiotic stewardship. A significant contributing factor was the inappropriate broad-spectrum antibiotic prescribing for urinary tract infections and the overdiagnosis of UTIs in patients presenting with frailty syndromes.
Methods
This quality improvement audit prospectively collected data from 75 elderly patients (over 65 years) admitted to a General Internal Medicine Ward, focusing on those diagnosed with UTIs or undergoing urinary culture. Key data points included patient demographics, catheterization status, presenting symptoms, urine dipstick usage, culture collection methods, and antibiotic prescription patterns. Interventions included the display of an informational poster on asymptomatic bacteriuria and a dedicated educational teaching session for clinicians.
Results
Initial findings revealed suboptimal adherence to national guidelines, with 22% of asymptomatic patients with negative cultures inappropriately prescribed antibiotics. Following the poster intervention, clinicians’ ability to differentiate UTI symptoms from frailty syndromes improved, with 45% of asymptomatic patients showing negative cultures. After the teaching session, 73% of asymptomatic patients had negative cultures, and antibiotic prescribing accuracy for ASB improved from 10% (baseline) to 57%. The inappropriate ASB treatment rate decreased to 14% by April 2024. Catheter-associated infections also showed a significant reduction, correlating with improved catheter management practices.
Conclusion
Targeted educational interventions, including informational posters and teaching sessions, significantly improved appropriate diagnosis and antibiotic prescribing for UTIs and ASB in elderly hospitalized patients. These efforts enhanced antibiotic stewardship, reduced unnecessary antibiotic exposure, and mitigated risks associated with antimicrobial resistance.
