scholarly journals 1112. Improving Urine Culturing Practices in a Neurocritical Care Unit through a Multidisciplinary Algorithm-Based Approach

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S396-S396
Author(s):  
Dana Hazen ◽  
William Snyderman ◽  
Josh Sadowski ◽  
Kristen Kelley ◽  
Cole Beeler ◽  
...  
Keyword(s):  
Neurocritical Care ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Use ◽  
P Value ◽  
Improvement Project ◽  
Increased Risk ◽  
High Prevalence ◽  
Implementation Time ◽  
Culture Algorithm

Abstract Background Asymptomatic bacteriuria is common in hospitalized patients with urinary catheters. Inappropriate urine culturing as part of reflexive response to fever contributes to unnecessary and excessive antibiotic use, selection for resistant organisms, increased risk for Clostridium difficile infections, and false elevation in catheter-associated urinary tract infection (CAUTI) rates. This project aimed to implement an evidence-based urine culture algorithm in a 33-bed neurocritical care unit, a unit with a historically elevated CAUTI rate due to a high prevalence of noninfectious fever. Methods A multidisciplinary quality improvement project was initiated in August 2018 by the Infection Prevention, Quality and Safety, Neurocritical Care, Trauma, and Neurosurgery teams of an urban academic health center. The group implemented a urine culture algorithm that was adapted from the Infectious Diseases Society of America (IDSA) guidelines that clearly highlighted appropriate indications for sending urine cultures. The team agreed to utilize a urinalysis with reflex to culture as the preferred method to evaluate for CAUTI. The algorithm was implemented in September 2018. Outcomes were compared for pre-implementation (March-August 2018) and post-implementation (September 2018–February 2019). Results The NHSN CAUTI rate decreased from 4.52/1,000 Foley days to 1.27/1,000 Foley days (P-value 0.037) as a result of the intervention. The number of urine cultures ordered decreased by 82% after implementation. No cases of bacteremia or mortality secondary to a urinary source were identified during the project. Total days of antibiotic therapy for the unit was similar between the pre- and post-implementation time periods (P = 0.631). Conclusion Implementation of a urine culture algorithm in a neurocritical care unit resulted in reduced CAUTI rate with less financial and operational waste in unnecessary orders and treatment, without resulting in adverse events to patients as a result of missed diagnosis. Disclosures All authors: No reported disclosures.

scholarly journals 238. Novel Way to Evaluate Antibiotic Use Appropriateness: Moving Towards the “Never Event” Classification by Electronic Algorithm

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S119-S120
Author(s):  
Twisha S Patel ◽  
Lindsay A Petty ◽  
Jiajun Liu ◽  
Marc H Scheetz ◽  
Nicholas Mercuro ◽  
...  
Keyword(s):  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Use ◽  
Data Capture ◽  
Electronic Data Capture ◽  
Electronic Data ◽  
False Positivity ◽  
Never Event ◽  
Manual Review

Abstract Background Antibiotic use is commonly tracked electronically by antimicrobial stewardship programs (ASPs). Traditionally, evaluating the appropriateness of antibiotic use requires time- and labor-intensive manual review of each drug order. A drug-specific “appropriateness” algorithm applied electronically would improve the efficiency of ASPs. We thus created an antibiotic “never event” (NE) algorithm to evaluate vancomycin use, and sought to determine the performance characteristics of the electronic data capture strategy. Methods An antibiotic NE algorithm was developed to characterize vancomycin use (Figure) at a large academic institution (1/2016–8/2019). Patients were electronically classified according to the NE algorithm using data abstracted from their electronic health record. Type 1 NEs, defined as continued use of vancomycin after a vancomycin non-susceptible pathogen was identified, were the focus of this analysis. Type 1 NEs identified by automated data capture were reviewed manually for accuracy by either an infectious diseases (ID) physician or an ID pharmacist. The positive predictive value (PPV) of the electronic data capture was determined. Antibiotic Never Event (NE) Algorithm to Characterize Vancomycin Use Results A total of 38,774 unique cases of vancomycin use were available for screening. Of these, 0.6% (n=225) had a vancomycin non-susceptible pathogen identified, and 12.4% (28/225) were classified as a Type 1 NE by automated data capture. All 28 cases included vancomycin-resistant Enterococcus spp (VRE). Upon manual review, 11 cases were determined to be true positives resulting in a PPV of 39.3%. Reasons for the 17 false positives are given in Table 1. Asymptomatic bacteriuria (ASB) due to VRE in scenarios where vancomycin was being appropriately used to treat a concomitant vancomycin-susceptible infection was the most common reason for false positivity, accounting for 64.7% of false positive cases. After removing urine culture source (n=15) from the algorithm, PPV improved to 53.8%. Conclusion An automated vancomycin NE algorithm identified 28 Type 1 NEs with a PPV of 39%. ASB was the most common cause of false positivity and removing urine culture as a source from the algorithm improved PPV. Future directions include evaluating Type 2 NEs (Figure) and prospective, real-time application of the algorithm. Disclosures Marc H. Scheetz, PharmD, MSc, Merck and Co. (Grant/Research Support)

scholarly journals 85. Evaluation of Urinalysis and Urine Culture Use at a Community Health-system

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S158-S159
Author(s):  
Martin Brenneman ◽  
Brian C Bohn ◽  
Sarah E Moore ◽  
Ashley Wilde ◽  
Ashley Wilde ◽  
...  
Keyword(s):  
Health System ◽  
Community Health ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Use ◽  
Point Prevalence Study ◽  
Target Sample Size ◽  
Potential Impact ◽  
Urine Testing ◽  
Unnecessary Testing

Abstract Background The Infectious Diseases Society of America asymptomatic bacteriuria (ASB) guidelines recommend against screening for or treating ASB in most patients without symptoms of a urinary tract infection (UTI). The purpose of this study was to characterize current urine testing practices and their potential impact on identification and treatment of asymptomatic bacteriuria on hospitalized adults. Methods This retrospective, point prevalence study conducted at a 4 hospital community health-system that included all inpatients ≥ 18 years old present on November 13th, 2019. Patients were excluded if they were admitted or transferred to either a labor & delivery or mother-baby unit. A chart review was performed for a sub-group of patients with abnormal urine testing, with a target sample size of 200 (n=50 from each hospital). The primary outcome was the prevalence of patients with a urinalysis, urine culture, or both performed during their admission. Secondary outcomes included abnormal urine testing in the overall cohort and symptomatology and antibiotic use in the sub-group (Figure 1). Results 947 patients met inclusion criteria. Of those patients, 516 (54%) had urine testing performed during their admission. 322 (34%) patients had abnormal urine testing results (Table 1). In the sub-group, 192 patients with abnormal urine tests were included. Antibiotics with a documented indication of UTI were administered to 66 (34%) patients. Of those given antibiotics with a UTI indication, 49/66 (74%) did not have documented signs or symptoms of a UTI (Figure 2). Conclusion Urine testing was performed on the majority of admitted adult patients. Unnecessary testing likely contributes to guideline discordant screening and treatment of ASB. Future studies are needed to identify effective diagnostic stewardship interventions to decrease screening and treatment of ASB. Disclosures Ashley Wilde, PharmD, BCPS-AQ ID, Nothing to disclose

scholarly journals Treatment of Asymptomatic Bacteriuria after Implementation of an Inpatient Urine Culture Algorithm in the Electronic Medical Record

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 138
Author(s):  
Dianne Osiemo ◽  
Danny K. Schroeder ◽  
Donald G. Klepser ◽  
Trevor C. Van Schooneveld ◽  
Andrew B. Watkins ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Urine Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Asymptomatic Bacteriuria ◽  
Provider Education ◽  
Quasi Experimental ◽  
Culture Algorithm ◽  
Over Time

Ordering urine cultures in patients without pyuria is associated with the inappropriate treatment of asymptomatic bacteriuria (ASB). In 2015, our institution implemented recommendations based on practice guidelines for the management of ASB and revised the urine culture ordering process to limit cultures in immunocompetent patients without pyuria. The purpose of this study was to determine how the treatment of ASB has changed over time since altering the urine culture ordering process to reduce unnecessary cultures at an academic medical center. A quasi-experimental study was conducted for inpatients with urine cultures from January to March of 2014, 2015, 2016 and 2020. The primary outcome was the antibiotic treatment of asymptomatic bacteriuria for over 24 h. The secondary outcomes were the total days of antibiotic therapy, type of antibiotic prescribed and overall urine culture rates at the hospital. A total of 200 inpatients with ASB were included, 50 at random from each year. In both 2014 and 2015, 70% of the patients with ASB received antibiotic treatment. Antibiotics were prescribed to 68% and 54% of patients with ASB in 2016 and 2020, respectively. The average duration of therapy decreased from 5.12 days in 2014 to 3.46 days in 2020. Although the urine cultures were reduced, there was no immediate impact in the prescribing rates for patients with ASB after implementing this institutional guidance and an altered urine culture ordering process. Over time, there was an observed improvement in prescribing and the total days of antibiotic therapy. This could be attributed to increased familiarity with the guidelines, culture ordering practices or improved documentation. Based on these findings, additional provider education is needed to reinforce the guideline recommendations on the management of ASB.

scholarly journals Screening for GDM in first trimester of pregnancy and its outcome

2018 ◽  
Vol 6 (2) ◽  
pp. 603
Author(s):  
Mamata Soren ◽  
Sudhanshu Sekhar Nath ◽  
Debananda Tudu ◽  
Polaki Srilekha
Keyword(s):  
Universal Screening ◽  
Single Case ◽  
Test Procedure ◽  
Perinatal Outcomes ◽  
First Trimester ◽  
Undiagnosed Diabetes ◽  
P Value ◽  
Increased Risk ◽  
High Prevalence ◽  
First Trimester Of Pregnancy

Background: GDM is associated with increased risk of complications for both mother and fetus both during pregnancy as well as in the postpartum period. Screening for GDM is important to improve short and long term maternal and fetal outcomes. The main purpose of this review is to provide an update on screening for GDM. As per DIPSI criteria women can be diagnosed to have GDM in the first trimester, if the 2hour 75gms OGTT IS 140-199 mg/dL. A prospective observational study with 300 cases was conducted for a period of 1year and 11months (December 2012-2014) in VIMSAR Burla, Sambalpur.Methods: Universal screening was applied by means of DIPSI. Analysis was done by means of t-test, Odd’s ratio, chi squire test. P<.05 was taken as significant.Results: In the present study, 25 cases were diagnosed as GDM with an incidence of 8.33%. Hypertensive disorders of pregnancy (HDP) was found significantly associated with GDM cases (p value 0.02). The mean birth weight in women with GDM (3.05±0.47Kg) was higher than in women with non-GDM (2.65±0.43 Kg). Overall the macrosomia (≥4Kg) rate was 0.67% with 8% in case of GDM mothers. Not a single case of congenital fetal anomaly was detected in the GDM group under our study 20% of the GDM group had their babies admitted to NICU as compared to 17.65% of the non-GDM group (p value 0.76).Conclusions: Women with GDM are at an increased risk for adverse obstetrics and perinatal outcomes. Due to high prevalence of GDM in India early universal screening is essential. Screening for glucose intolerance during the early weeks of pregnancy is beneficial as this policy would help in identifying undiagnosed diabetes prior to conception and to render appropriate care. Screening and diagnosis of GDM with a single test procedure of 75g 2hr PGBS in a non-fasting woman i.e. following DIPSI guidelines is found to be effective, simple, economical and feasible. 

Importance of Urinary Tract Infection to Antibiotic Use Among Hospitalized Patients

2009 ◽  
Vol 30 (2) ◽  
pp. 193-195 ◽  
Author(s):  
Tejal Gandhi ◽  
Scott A. Flanders ◽  
Erica Markovitz ◽  
Sanjay Saint ◽  
Daniel R. Kaul
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Broad Spectrum ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Broad Spectrum Antibiotics

Many patients with asymptomatic bacteriuria receive extended courses of broad-spectrum antibiotics. Antibiotic use was analyzed in patients admitted to the hospital with urinary tract infection. Strategies to optimize antibiotic use for such patients are discussed and include implementing a process whereby a urine culture is automatically performed if a urinalysis result suggests infection.

scholarly journals Knowledge of Antibiotic Use in College Students: A Quality Improvement Project

2018 ◽  
Vol 2 (2) ◽  
pp. 21 ◽  
Author(s):  
Katie Moes ◽  
Catherine Carrico ◽  
Alexander Hall
Keyword(s):  
College Students ◽  
Educational Intervention ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Antibiotic Use ◽  
Basic Knowledge ◽  
Improvement Project ◽  
Upper Respiratory Infection ◽  
Increased Risk ◽  
College Aged Students

Aim: To evaluate college students' knowledge, attitudes, and beliefs about antibiotic use for simple viral infections, as well as determine if knowledge could be improved through an educational intervention and examine impacts on overall patient satisfaction.Background: Antibiotic resistance is a growing problem. College-aged students are at an increased risk for simple respiratory infections due to their close living conditions and poor knowledge of appropriate antibiotic use (Smith, Rigassio-Radler, Denmark, Haley, & Touger-Decker, 2012; Turner & Keller, 2015).Methods: Students (N = 44) age 19-25 seen at the college health center of a small, private Nebraska university presenting with symptoms of an upper respiratory infection (URI) were given a survey prior to seeing the healthcare provider. During the visit, providers reviewed an educational handout discussing appropriate antibiotic use for URIs and then gave the student a post-survey to complete.Results: Students' Basic Knowledge of antibiotics improved, p = .1, Cohen's d = 0.41 as a result of the educational intervention, while changes in knowledge about Efficacy and Provider trust was mixed. Knowledge of correct use/misuse was high at pre, M = 1.95 and post M = 1.93.Conclusions: College-aged students benefit from additional education about antibiotics. Based on this project's findings, educational handouts have the potential to improve knowledge regarding antibiotics.

scholarly journals 1476. The Role of Empirical Antibiotics Determined by Pre-procedural Urinalysis and Urine Cultures in Elective Urological Interventions

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S538-S539
Author(s):  
Georgia Smith ◽  
Patrick Chung Kay ◽  
Rick Catterwell ◽  
Renjy Nelson ◽  
Morgyn Warner
Keyword(s):  
Urine Culture ◽  
Antibiotic Use ◽  
Adverse Outcomes ◽  
Positive Urine Culture ◽  
Post Intervention ◽  
Patient Demographics ◽  
Increased Risk ◽  
Urological Procedures ◽  
Empirical Antibiotics

Abstract Background At a urology center in Australia, patients undergoing elective nonurgent urological surgery routinely receive empirical antibiotic treatment based on urinalysis (UA) prior to intervention to treat presumptive bacteriuria. Sterilization of urine with empirical antibiotics in procedures involving stone manipulation and mucosal disruption in the genitourinary system has been shown to reduce infection risks but whether this translates to low-risk urological interventions is not clear. Methods Patients undergoing outpatient elective urological procedures during a 3-month period between September and November 2017 were retrospectively reviewed. Patient demographics, results of urinalyses, empirical antibiotic use, and data surrounding post-intervention complications were collected and reviewed. Results were analyzed using SPSS v 25. Results Of 119 patients, 111 underwent a pre-procedure urinalysis. Fifty-eight percent (n = 64) of patients were treated with empiric antibiotics pre-operatively based on a positive UA (defined as the presence of urinary leukocytes or nitrites). Fifty-five percent (n = 41) of patients who received empirical antibiotics returned a positive urine culture, and only 49 percent (n = 20) of those receiving antibiotics cultured organisms susceptible to initial antibiotics prescribed. 1 Death, 3 incidences of bacteremia, and 10 incidences of bacteriuria up to 2 weeks occurred post-intervention in this cohort. There was no discernible risk of adverse events based on a composite of post-intervention death, bacteremia and bacteriuria in patients with a positive pre-procedural UA (n = 67/111, RR0.67 CI 0.49–0.91, P = 0.10). Pre-procedural sterilized urine similarly did not demonstrated any reduced risk of post-intervention adverse outcomes (n = 77/119, RR1.02 CI 0.64–1.63, P = 0.94). Conclusion This study demonstrated no increased risk of post-operative infection in patients with a positive urinalysis or urine culture with bacteriuria prior to intervention. There was a high use of broad-spectrum antibiotic as a reflex to positive urinalyses alone highlighting an avenue for improved anti-microbial stewardship. More research is needed to guide clinicians on the role of urine cultures and antibiotics prior to non-urgent urological procedures. Disclosures All authors: No reported disclosures.

scholarly journals Study of anemia in diabetes and its association with diabetic retinopathy

2017 ◽  
Vol 4 (5) ◽  
pp. 1437 ◽  
Author(s):  
Archana Kansal ◽  
Mahendra Chouhan ◽  
Neelima Singh ◽  
Sushma Trikha ◽  
Jijo Verghese
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Kidney Diseases ◽  
Vascular Complications ◽  
P Value ◽  
Diabetic Patients ◽  
Capillary Method ◽  
Increased Risk ◽  
High Prevalence ◽  
Patients With Diabetes

Background: Anemia is an increasingly recognized entity in patients with diabetes mellitus. Reduced hemoglobin levels identify diabetic patients with an increased risk of microvascular complications.Methods: A hospital based observational prospective study was conducted in Department of medicine, J.A. Group of Hospitals, Gwalior from June 2014 to October 2015. Adults with diabetes mellitus both type 1 and type 2 were selected as subjects are included and anemia due to blood loss and anemia due to chronic kidney diseases were excluded from the study. Estimation of hemoglobin was done by using capillary method by calorimetric hemoglobinometer. Anemia was defined as hemoglobin <13 g/dl in men and <12 g/ dl in women. All the patients were examined for diabetic retinopathy and graded as none, mild, moderate, severe and proliferative retinopathy as per International clinical diabetic retinopathy disease severity scale.Results: 100 patients were enrolled as subjects. Most of the patients 26 (26%) were in the age group 46-55 years. There were 53 males and 47 females. 42%, 45% and 13% had diabetes of <5 years, 5-10 years and > 10 years duration respectively. HbA1c levels were <7.5 in 74 (74%), 7.5-10 in 23 (23%) patients and > 10 in 3 (3%) patients. Overall 67 (67%) diabetics had anemia. Out of 53 males 30 (56.6%) had anemia and amongst females, out of 47 cases 37 (78.72%) had anemia P value 0.009. Anemia was more common in patients less than 50 years 36 (70.59%) compared to31 (63.2%) with anemia in patients more than 50 years. 65 (65%) patients had diabetic retinopathy (DR). 30 (46.1%) males and 35 (53.8%) females had diabetic retinopathy. All patients with diabetic retinopathy had anemia. Among 35 (35%) patients without DR only 2 (5.71%) had anemia. P value <0.001.Conclusions: Anemia is a common accompaniment to diabetes. Anemia was more common in females and in those less than 50 years. Anemia was frequently associated with diabetic retinopathy. The high prevalence of anaemia supports regular screening for anemia, alongside that for other diabetes-related complications. This might help to delay the progression of vascular complications in these patients.  

scholarly journals 15. Leveraging Data to Explore the Consequences of Urine Testing and Antibiotic Use During the Spinal Cord Injury Annual Evaluation

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S8-S9
Author(s):  
Sarah B May ◽  
Annette Walder ◽  
S Ann Holmes ◽  
Ivy Poon ◽  
Charlesnika T Evans ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Positive Culture ◽  
Antibiotic Use ◽  
Health Administration ◽  
Comorbidity Score ◽  
Cord Injury ◽  
Urine Testing

Abstract Background The Veterans’ Health Administration (VHA), currently mandates that every spinal cord injury and disorder (SCI/D) patient receives a screening urinalysis and urine culture (UC) during the annual evaluation (AE). Our pilot study at a single VHA center showed that 87% of the UCs obtained during the AE represented asymptomatic bacteriuria (ASB), and that 35% of those UC were treated with antibiotics unnecessarily. The objective of the current study is to determine the association between UC and antibiotic use using a national VHA sample of SCI/D patients. Methods Retrospective cohort of Veterans who presented to a VHA SCI/D clinic for their AE in FY18 or FY19. Demographic and clinical characteristics as well as information on primary outcomes (receipt of urine culture and antibiotics) were extracted from the VHA Corporate Data Warehouse. Associations between covariates and outcomes were assessed using logistic regression. P values &lt; 0.05 were considered significant. Results 9447 veterans with SCI/D were included, of whom 5088 (54%) had a UC obtained. Of those with a UC, 2910 (57%) were classified as positive (Figure 1). 1054 (11%) veterans were prescribed antibiotics within 7 days of their AE. Of these, 515 had a positive UC, 202 had a negative UC, and 2878 did not have a UC obtained during the AE. Age, ethnicity, neurologic level of injury (NLI), comorbidity score, frequently identified organism on positive culture, and receipt of antibiotics within 7 days of AE were significantly associated with obtaining a UC during the AE. Race, NLI, bladder management strategy, comorbidity score, frequently identified organism on positive culture, and having a UC obtained during the AE were significantly associated with receipt of antibiotics within 7 days of AE. Flowchart of SCI/D Veterans who had a urine culture and/or received antibiotics during their FY18/19 AE Conclusion Over half of Veterans with SCI/D presenting for their AE receive a screening UC, contrary to other national guidelines recommending against this practice. Age and type or organism identified on UC drive antibiotic use, which was similar to our previous findings and reflect themes identified during our qualitative interviews with SCI/D providers. The knowledge gained from this national VA study will assist the development of interventions to reduce unnecessary urine testing and antibiotic use in the SCI/D population. Disclosures All Authors: No reported disclosures

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