Krouss Mona, Alaiev Daniel, Shin Da Wi, Talledo Joseph, Israilov Sigal, Chandra Komal, Zaurova Milana, Manchego Peter Alacron, Tsega Surafel, Cohen Gabriel, Bravo Nathaniel, Kupferman Tania, Madaline Theresa, Cho Hyung J
Department of Quality and Safety, NYC Health + Hospitals, New York, NY; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Quality and Safety, NYC Health + Hospitals, New York, NY.
Am J Infect Control. 2023 Apr;51(4):461-465. doi: 10.1016/j.ajic.2023.01.005. Epub 2023 Mar 2.
Treatment of asymptomatic bacteriuria (ASB) is common. Overtreatment of ASB leads to harm, including adverse effects from antibiotics, antibiotic resistance, and increased length of stay.
This quality improvement initiative targeted inappropriate urine cultures across 11 hospitals in a safety-net setting. A mandatory prompt for appropriate indications for urine culture orders and a best practice advisory (BPA) for urine culture on patients with urinary catheters were created. Urine culture ordering was compared pre-intervention (6/2020 to 10/2021) to post-intervention (12/2021 to 8/2022). Catheter associated urinary tract infections (CAUTI) was compared pre- and post-intervention. Variation in urine culture ordering and CAUTI rates in hospitals were assessed.
Inpatient urine cultures decreased by 20.9% (p<0.001). Inpatient urine cultures on patients with urinary catheters decreased by 21.6% (p<0.001). CAUTI rates remained unchanged post-intervention. High variation in urine culture ordering and CAUTI rates was seen among hospitals.
This initiative successfully decreased urine cultures in a large, safety-net system. Further study is needed in assessing variation among hospitals.
无症状菌尿（ASB）的治疗很常见。对ASB的过度治疗会导致危害，包括抗生素的不良反应、抗生素耐药性以及住院时间延长。
这项质量改进计划针对安全网环境下11家医院中不适当的尿培养。制定了关于尿培养医嘱适当指征的强制性提示以及针对导尿患者尿培养的最佳实践建议（BPA）。将干预前（2020年6月至2021年10月）与干预后（2021年12月至2022年8月）的尿培养医嘱情况进行比较。对干预前后的导尿管相关尿路感染（CAUTI）情况进行比较。评估医院尿培养医嘱和CAUTI发生率的差异。
住院患者尿培养减少了20.9%（p<0.001）。导尿患者的住院患者尿培养减少了21.6%（p<0.001）。干预后CAUTI发生率保持不变。各医院在尿培养医嘱和CAUTI发生率方面存在很大差异。
该计划成功减少了大型安全网系统中的尿培养。需要进一步研究以评估医院之间的差异。
