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Upstream Intervention Effective in Reducing Unnecessary Antibiotic Prescriptions


  • About one-third of hospitalized patients treated for urinary tract infections have asymptomatic bacteriuria.
  • ASB is commonly treated with unnecessary antibiotics.
  • Across 46 hospitals, researchers found that interventions at the time of diagnosis, or diagnostic stewardship, resulted in a decrease over time in unnecessary antibiotic treatment for ASB.

Diagnostic stewardship is more effective than antibiotic stewardship at reducing unnecessary antibiotic use for patients treated for urinary tract infections who have asymptomatic bacteriuria, according to research presented at IDWeek. UTIs are one of the most common bacterial infections and a significant driver of global antimicrobial resistance.

In a four-year study across 46 hospitals that implemented pay-for-performance metrics related to unnecessary treatment of ASB, the percentage of patients treated with antibiotics for UTIs who had ASB declined from 29.0% to 16.9%. Diagnostic stewardship — making sure patients receive the right tests at the right time — appeared responsible for nearly all improvement.

“Most efforts to combat antimicrobial resistance have focused on prescribing, but our research indicates that more progress can be made by looking further upstream — before a prescription is ever written,” said Valerie Vaughn, MD, MSc, Director of Hospital Medicine Research at the University of Utah. “Diagnostic stewardship is an important and effective part of overall responsible antibiotic use in health care settings.”

About one-third of hospitalized patients treated for UTIs have ASB, which is when bacteria are in the urine but do not present symptoms or cause infection. Up to 80% of patients who have ASB are treated with antibiotics that they don't need, which can lead to increased antibiotic resistance without improving patient outcomes.

“Our study focused on hospitalized patients, but it’s a critical issue for patients in long-term care or skilled nursing facilities, because patients who have asymptomatic bacteria tend to be older and chronically ill,” said Vaughn. “These patients are already more likely to experience adverse events from antibiotics, so responsible antibiotic usage is especially important for those health care providers to address.”

In addition to Dr. Vaughn, co-authors of the paper include: Ashwin Gupta, MD; Lindsay A. Petty, MD; Anurag N. Malani, MD, FIDSA, FSHEA; Danielle Osterholzer, MD; Payal K. Patel, MD, MPH; Mariam Younas, MD; Steven Bernstein, MD, MPH; David Ratz, MS; Elizabeth McLaughlin, BSN, MS; Tawny Czilok, MHI, BSN, RN; Jennifer Horowitz, MA; Scott A. Flanders, MD; and Tejal N. Gandhi, MD.

About IDWeek
IDWeek is the joint annual meeting of the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists. IDWeek is a recognized forum for peer-reviewed presentations of new research on scientific advances and bench-to-bedside approaches in prevention, diagnosis, treatment and epidemiology of infectious diseases, including HIV, across the lifespan. For more information, visit

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