Targeting Overtreatment of Asymptomatic Bacteriuria in the Emergency Department : Results from a Quasi-Experimental Clinical Pharmacist-Led Program Based on Education and Audit
Monje, Alvaro (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Escolà-Vergé, Laura (Institut de Recerca Sant Pau)
Rivera, Alba (Institut de Recerca Sant Pau)
Herrera, Sergio (Institut de Recerca Sant Pau)
Plaza Díaz, Adrián (Institut de Recerca Sant Pau)
Duch Llorach, Pol (Hospital Universitari Vall d'Hebron)
Pomar, Virginia (Institut de Recerca Sant Pau)
Roch Villaverde, Nerea (Institut de Recerca Sant Pau)
Rouras, Laia (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
López-Contreras, Joaquín 1963- (Institut de Recerca Sant Pau)
Ruiz Ramos, Jesús (Institut de Recerca Sant Pau)
Universitat Autònoma de Barcelona. Departament de medicina

Data:	2025
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Asymptomatic bacteriuria ; Emergency department ; Audit and feedback ; Urinary tract infection ; Urine culture
Publicat a:	Antibiotics, Vol. 14 (December 2025) , art. 1261, ISSN 2079-6382

DOI: 10.3390/antibiotics14121261
PMID: 41463763

13 p, 1.1 MB

El registre apareix a les col·leccions:
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
Articles > Articles de recerca
Articles > Articles publicats