Urinary tract infections (UTI) are one of the most common reasons for the prescription of antibiotics. However, this is not always useful. Asymptomatic bacteriuria (ASB), the presence of bacteria in a patients urine, without symptoms of an UTI is often found in older patients with an urinary bladder catheter. However, antibiotic treatment of ASB has been shown to be one of the most utilized low-value procedures. (Inter)national guidelines advise to refrain from treatment in patients with ASB, except when the patient is part of certain risk groups. The treatment of ASB with antibiotics is ineffective and could have negative consequences, such as side effects, interactions with other drugs, antimicrobial resistance, increased risk of developing an UTI in the future and increased costs.
A systematic review and meta-analysis from 2017 shows that 45% of 4129 patients (95% CI 39-50) received inappropriate antibiotics for ASB. The prevalence in Dutch hospitals is unknown. However, a prospective study from 2015 performed in 10 Dutch nursery homes showed that 115 of 356 (32%) of its inhabitants possibly received antibiotics for their UTI. The most prevalent inappropriate indication was an ASB.
The project is considered successful when a reduction of 50% in low-value antibiotic treatments of ASB is realized.
‘The thought: ‘better safe than sorry’, is not correct’
A stepped-wedge cluster randomized design will be used, in which the deïmplementation strategy will be applied to the emergency departments of four hospitals. The deïmplementation strategy will consist of a combination of interventions, such as education, feedback and reminders. The strategy will be customized for each location. On each location a local champion will be assigned, whom will be responsible for the progress of the project within their own hospital.
Starting
Planned intervention start: May 2020
Planned duration: 1 year.
Contact us at info@doenoflaten.nl
