{"id":24359,"date":"2023-08-06T04:07:00","date_gmt":"2023-08-05T20:07:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24359"},"modified":"2023-08-06T06:36:32","modified_gmt":"2023-08-05T22:36:32","slug":"jama-intern-med%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%87%8f%e5%b0%91%e4%b8%8d%e5%bf%85%e8%a6%81%e6%8a%97%e7%94%9f%e7%b4%a0%e6%b2%bb%e7%96%97%e6%97%a0%e7%97%87%e7%8a%b6%e8%8f%8c%e5%b0%bf","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24359","title":{"rendered":"[JAMA Intern Med\u53d1\u8868\u8bba\u6587]\uff1a\u51cf\u5c11\u4e0d\u5fc5\u8981\u6297\u751f\u7d20\u6cbb\u7597\u65e0\u75c7\u72b6\u83cc\u5c3f\u7684\u5dde\u653f\u5e9c\u8d28\u91cf\u6539\u8fdb\u8ba1\u5212"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

July 10, 2023<\/p>\n\n\n\n

A Statewide Quality Initiative to Reduce Unnecessary Antibiotic Treatment of Asymptomatic Bacteriuria<\/h1>\n\n\n\n

Valerie M.\u00a0Vaughn,\u00a0Ashwin\u00a0Gupta,\u00a0Lindsay A.\u00a0Petty,\u00a0et al<\/h3>\n\n\n\n

JAMA Intern Med.\u00a0<\/em>Published online July 10, 2023. doi:10.1001\/jamainternmed.2023.2749<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Is stewardship focused on diagnostic testing or antibiotic treatment associated with reduced asymptomatic bacteriuria (ASB) treatment in hospitalized patients?<\/p>\n\n\n\n

Findings<\/strong>  In this 3-year, 46-hospital quality improvement study including 14\u202f572 patients with positive urine cultures, the percentage of patients with a positive urine culture who had ASB declined from 34.1% to 22.5%, suggesting more selective urine testing. In contrast, the percentage of patients with ASB who received antibiotics and antibiotic duration for ASB remained relatively stable.<\/p>\n\n\n\n

Meaning<\/strong>  To decrease antibiotic treatment related to ASB, hospitals should prioritize reducing unnecessary urine cultures (ie, diagnostic stewardship).<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Hospitalized patients with asymptomatic bacteriuria (ASB) often receive unnecessary antibiotic treatment, which increases antibiotic resistance and adverse events.<\/p>\n\n\n\n

Objective<\/strong>  To determine whether diagnostic stewardship (avoiding unnecessary urine cultures) or antibiotic stewardship (reducing unnecessary antibiotic treatment after an unnecessary culture) is associated with better outcomes in reducing antibiotic use for ASB.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This 3-year, prospective quality improvement study included hospitalized general care medicine patients with a positive urine culture among 46 hospitals participating in a collaborative quality initiative, the Michigan Hospital Medicine Safety Consortium. Data were collected from July 1, 2017, through March 31, 2020, and analyzed from February to October 2022.<\/p>\n\n\n\n

Exposure<\/strong>  Participation in the Michigan Hospital Medicine Safety Consortium with antibiotic and diagnostic stewardship strategies at hospital discretion.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  Overall improvement in ASB-related antibiotic use was estimated as change in percentage of patients treated with antibiotics who had ASB. Effect of diagnostic stewardship was estimated as change in percentage of patients with a positive urine culture who had ASB. Effect of antibiotic stewardship was estimated as change in percentage of patients with ASB who received antibiotics and antibiotic duration.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Of the 14\u202f572 patients with a positive urine culture included in the study (median [IQR] age, 75.8 [64.2-85.1] years; 70.5% female); 28.4% (n\u2009=\u20094134) had ASB, of whom 76.8% (n\u2009=\u20093175) received antibiotics. Over the study period, the percentage of patients treated with antibiotics who had ASB (overall ASB-related antibiotic use) declined from 29.1% (95% CI, 26.2%-32.2%) to 17.1% (95% CI, 14.3%-20.2%) (adjusted odds ratio [aOR], 0.94 per quarter; 95% CI, 0.92-0.96). The percentage of patients with a positive urine culture who had ASB (diagnostic stewardship metric) declined from 34.1% (95% CI, 31.0%-37.3%) to 22.5% (95% CI, 19.7%-25.6%) (aOR, 0.95 per quarter; 95% CI, 0.93-0.97). The percentage of patients with ASB who received antibiotics (antibiotic stewardship metric) remained stable, from 82.0% (95% CI, 77.7%-85.6%) to 76.3% (95% CI, 68.5%-82.6%) (aOR, 0.97 per quarter; 95% CI, 0.94-1.01), as did adjusted mean antibiotic duration, from 6.38 (95% CI, 6.00-6.78) days to 5.93 (95% CI, 5.54-6.35) days (adjusted incidence rate ratio, 0.99 per quarter; 95% CI, 0.99-1.00).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  This quality improvement study showed that over 3 years, ASB-related antibiotic use decreased and was associated with a decline in unnecessary urine cultures. Hospitals should prioritize reducing unnecessary urine cultures (ie, diagnostic stewardship) to reduce antibiotic treatment related to ASB.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  July 10, 2023 A […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24359"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24359"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24359\/revisions"}],"predecessor-version":[{"id":24360,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24359\/revisions\/24360"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24359"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24359"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24359"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}