Bacteriuria in a Geriatric Hospital: Impact of an Antibiotic Improvement Program

Objectives To prospectively evaluate a management approach to bacteriuria including advice from an infectious diseases consultant (IDC) in geriatric inpatients. Design Prospective study from July 1, 2003, to June 30, 2004. Setting A 205-bed geriatric university-affiliated hospital. Participants Consecutive hospitalized patients with positive urine cultures. Intervention The hospital's infection control department developed recommendations about antimicrobial use for bacteriuria, which were discussed at staff meetings. Treatments for bacteriuria prescribed by ward physicians were reviewed by an IDC, who suggested changes where appropriate. Physicians were free to follow or to disregard the IDC's suggestions. Measurements Patients with positive urine cultures (UC) were classified as having asymptomatic bacteriuria (AB), urinary tract infection (UTI) or pyelonephritis (PN). Prescribed and actual treatments were compared. Results Of 252 consecutive positive UCs in 181 patients, 124 (49%) were classified as AB, 88 (35%) as UTI, and 38 (15%) as PN; 2 cases of prostatitis were excluded. The total number of prescribed antimicrobial days before IDC advice was 729 and the actual number (after IDC advice) was 577, for a 152-day (21%) reduction. Most of the reduction was generated by shortening the treatment duration. Conclusion Intervention of an IDC resulted in reduced antimicrobial use in older inpatients with bacteriuria.