A randomized controlled trial of modified reporting of urine cultures to reduce inappropriate treatment of asymptomatic bacteriuria

Abstract

45%-65% of patients with asymptomatic bacteriuria (ASB) are inappropriately treated with antimicrobials, leading to an increase in bacterial resistance, cost, and adverse health events. Positive urine culture seems to remarkably influence antimicrobial use in ASB. The purpose of this project is to answer the question of whether among inpatients with positive urine cultures, would modified reporting lead to a reduction in inappropriate therapy. The study was a randomized, parallel group, superiority trial, comparing two different ways to report positive urine cultures. In the intention-to-treat analysis, the proportion of appropriate treatment (UTI treated plus ASB not treated) in the modified arm was 44/55 (80.0%) vs. 29/55 (52.7%) in the standard arm, absolute difference= 27.3%, RR=0.42, p=0.002. Number needed to report for benefit=3.7. The overall difference in proportion of appropriate treatment was produced by a decrease in the number of ASB treated. Modified reporting did not increase the occurrence of adverse events.