71e1fdb5c282fbbb10e91a08a26ea24b 326414.pdf 40cd171a7464f61136358b625c4d6caf050789d6 326414.pdf ef74e64535f77d8efcc49f075dfd2c8d1497c95f612c131f365e8fd5874f4646 326414.pdf Title: Targeting Overtreatment of Asymptomatic Bacteriuria in the Emergency Department: Results from a Quasi-Experimental Clinical Pharmacist-Led Program Based on Education and Audit Subject: Background: Asymptomatic bacteriuria (ASB) is frequently overtreated in emergency departments (EDs), contributing to antimicrobial resistance without improving clinical outcomes. The rapid pace of clinical decision-making and high patient turnover in the ED further predispose clinicians to unnecessary antibiotic prescribing. Methods: A quasi-experimental study was conducted in the ED of a tertiary hospital in Barcelona, Spain, from January 2024 to September 2025. The intervention included targeted education for ED staff and daily audit-feedback on antibiotic prescriptions for suspected ASB. The outcomes were the following variables, compared between study periods: cases of ASB with unnecessary antibiotic treatment per month, antimicrobial consumption, urine culture (UC) requests, 30-day return visits to the ED for urinary tract infection, and 30-day all-cause mortality for safety assessment. Results: A total of 93 patients with suspected ASB in the pre-intervention period and 102 patients in the intervention period were included. The median cases of ASB with unnecessary antibiotic treatment per month decrease from 19 (IQR 16–26) in the pre-intervention period to 9 (IQR 9–13) in the intervention period (p = 0.018). Antimicrobial consumption declined: meropenem and imipenem decreased from 5.5 to 3.0 DDD/1000 admissions, ertapenem from 5.6 to 3.1, and ceftriaxone from 35.0 to 24.1. UC requests fell by 16.1%. Clinical safety outcomes did not differ significantly between periods: 30-day return visit to the ED for UTI with the same isolate dropped from 8.6% to 1.9% (p = 0.076), overall UTI return visits to the ED dropped from 11.8% to 5.9% (p = 0.225), and 30-day mortality remained stable (8.6% vs. 4.9%, p = 0.455). Conclusions: These findings support the use of combined educational and audit–feedback strategies as effective and safe Antimicrobial Stewardship interventions in high-intensity clinical environments such as the ED, as they reduce inappropriate antibiotic use and unnecessary UC requests without compromising patient safety. Keywords: asymptomatic bacteriuria; emergency department; audit and feedback; urinary tract infection; urine culture Author: Alvaro Monje, Laura Escolà-Vergé, Alba Rivera, Sergio Herrera, Adrián Plaza, Pol Duch-Llorach, Virginia Pomar, Nerea Roch, Laia Rouras, Joaquín López-Contreras and Jesús Ruiz Ramos Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Sun Dec 14 09:54:42 2025 CET ModDate: Sun Dec 14 10:10:44 2025 CET Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1104353 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- WNWTFR+VnURWPalladioL-Bold Type 1 Custom yes yes yes 96 0 SSXPJJ+VnURWPalladioL Type 1 Custom yes yes yes 97 0 DIWGYY+URWPalladioL-Bold Type 1 Custom yes yes yes 98 0 MNKLQX+URWPalladioL-Roma Type 1 Custom yes yes yes 99 0 NKWEGM+URWPalladioL-Ital Type 1 Custom yes yes yes 100 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 157 0 GQWIGS+CMSY10 Type 1 Builtin yes yes yes 158 0 ILNHIJ+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 138 0 ILNHIH+PalatinoLinotype TrueType WinAnsi yes yes no 139 0 ZYYJXI+EURB10 Type 1 Builtin yes yes yes 178 0 QWWHCD+EURM10 Type 1 Builtin yes yes yes 179 0 ILNHIH+PalatinoLinotype TrueType WinAnsi yes yes no 194 0 ILNHIF+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 195 0 ILNHIJ+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 206 0 ILNHIH+PalatinoLinotype TrueType WinAnsi yes yes no 207 0 ILNHIF+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 208 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-03-26 04:11:33 CET RepresentationInformation: 326414.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-03-25 13:49:50 CET Size: 1104353 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 383 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Results Children: Item: Title: Data Collection Item: Title: Description of the Sample of Patients with ASB Item: Title: Antibiotic Consumption Item: Title: Number of Urine Cultures Requests and Urine Cultures Item: Title: Clinical Outcomes Item: Title: Discussion Item: Title: Materials and Methods Item: Title: Limitations Item: Title: Conclusions Item: Title: References Info: Title: Targeting Overtreatment of Asymptomatic Bacteriuria in the Emergency Department: Results from a Quasi-Experimental Clinical Pharmacist-Led Program Based on Education and Audit Author: Alvaro Monje, Laura Escolà-Vergé, Alba Rivera, Sergio Herrera, Adrián Plaza, Pol Duch-Llorach, Virginia Pomar, Nerea Roch, Laia Rouras, Joaquín López-Contreras and Jesús Ruiz Ramos Subject: Background: Asymptomatic bacteriuria (ASB) is frequently overtreated in emergency departments (EDs), contributing to antimicrobial resistance without improving clinical outcomes. The rapid pace of clinical decision-making and high patient turnover in the ED further predispose clinicians to unnecessary antibiotic prescribing. Methods: A quasi-experimental study was conducted in the ED of a tertiary hospital in Barcelona, Spain, from January 2024 to September 2025. The intervention included targeted education for ED staff and daily audit-feedback on antibiotic prescriptions for suspected ASB. The outcomes were the following variables, compared between study periods: cases of ASB with unnecessary antibiotic treatment per month, antimicrobial consumption, urine culture (UC) requests, 30-day return visits to the ED for urinary tract infection, and 30-day all-cause mortality for safety assessment. Results: A total of 93 patients with suspected ASB in the pre-intervention period and 102 patients in the intervention period were included. The median cases of ASB with unnecessary antibiotic treatment per month decrease from 19 (IQR 16–26) in the pre-intervention period to 9 (IQR 9–13) in the intervention period (p = 0.018). Antimicrobial consumption declined: meropenem and imipenem decreased from 5.5 to 3.0 DDD/1000 admissions, ertapenem from 5.6 to 3.1, and ceftriaxone from 35.0 to 24.1. UC requests fell by 16.1%. Clinical safety outcomes did not differ significantly between periods: 30-day return visit to the ED for UTI with the same isolate dropped from 8.6% to 1.9% (p = 0.076), overall UTI return visits to the ED dropped from 11.8% to 5.9% (p = 0.225), and 30-day mortality remained stable (8.6% vs. 4.9%, p = 0.455). Conclusions: These findings support the use of combined educational and audit–feedback strategies as effective and safe Antimicrobial Stewardship interventions in high-intensity clinical environments such as the ED, as they reduce inappropriate antibiotic use and unnecessary UC requests without compromising patient safety. 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