Antibiotic superheroes: Improving asymptomatic bacteriuria management through academic detailing and provider comparison in the ambulatory care setting.

BACKGROUND

The presence of bacteria in the urine, without coinciding symptoms of infection, is classified as asymptomatic bacteriuria (ASB). Although ASB is common, the Infectious Disease Society of America guidelines discourage its treatment because most patients have no adverse health effects and derive no benefit from antibiotic drugs. Despite these guidelines, patients with ASB frequently receive antibiotic drugs, establishing the need for antimicrobial stewardship interventions.

OBJECTIVE

This study aimed to describe implementation of an antibiotic stewardship campaign targeting proper identification and management of ASB within the ambulatory care setting.

PRACTICE DESCRIPTION

An antibiotic stewardship campaign was implemented to facilitate prescribing behavior change. An academic detailer performed education outreach to primary care providers (PCPs). Robust conversation was used to deliver key messages focusing on PCP specific improvements. At the completion of the encounter, each PCP was provided with a unique "superhero" name and asked to commit to fight against treating ASB. Subsequently, the superhero name was used for blinded comparison of antibiotic prescribing trends among peers.

PRACTICE INNOVATION

The importance of antibiotic stewardship in the ambulatory care setting is increasingly recognized. We depict a stewardship initiative specific to ambulatory care, implemented at a health care system level, that meets the Joint Commission Standards first required in 2020.

EVALUATION METHODS

Positive urine cultures from November 1, 2018, to October 31, 2019, served as the preimplementation group, and cultures from November 1, 2020, to October 31, 2021, served as the postimplementation group. A retrospective chart review and logistic regression model were used to compare the antibiotic prescribing rate in ASB before and after the intervention.

RESULTS

The campaign was associated with a 92% reduction in the odds of antibiotic prescribing (odds ratio 0.08 [95% CI 0.04-0.17]) compared with the preimplementation period controlling for baseline covariates.

CONCLUSION

The utilization of academic detailing, bundled with audit and feedback, decreased the treatment of ASB and improved the quality of care received.