A randomized controlled trial of modified reporting of positive urine cultures to reduce inappropriate treatment of asymptomatic bacteriuria in long term care facilities

Rehan, Zahra (2023) A randomized controlled trial of modified reporting of positive urine cultures to reduce inappropriate treatment of asymptomatic bacteriuria in long term care facilities. Masters thesis, Memorial University of Newfoundland.

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Abstract

There is a high rate of inappropriate antibiotic treatment in long-term care facilities, prescribed for asymptomatic bacteriuria (ASB). We conducted a prospective, randomized and unblinded superiority trial to test whether modified reporting of positive urine cultures reduced inappropriate antibiotic treatment without increasing adverse events or mortality. Consecutive positive urine cultures collected from non-catheterized patients from 8 long-term care facilities in St. John’s, NL were randomized in the laboratory between a standard (identification and susceptibility) or modified (without identification and susceptibility) report, between November 2018 and June 2019. The patients were followed for thirty days after the report. The diagnosis of a urinary tract infection (UTI) and ASB were made following standard criteria using prospective chart review. 100 positive urine cultures were included in intention-to-treat analysis and 96 were included in per-protocol analysis. 62/100 (62%) patients were diagnosed with ASB and 38/100 (38%) with UTI. 41/62 (66%) patients with ASB were treated and 35/38 (92%) of patients with UTI were treated. In the modified reporting arm, the lab was called to report the identification and susceptibility in 30/51 (59%) reports. The rate of appropriate treatment (untreated ASB + treated UTI) was higher in the modified report arm compared to the standard report arm: 30/48 (63%) vs. 24/48 (50%), (+13%, RR=1.25, 95% CI (0.88, 1.79). There were 2/51 (3.9%) deaths in the modified arm and 0/49 (0%) deaths in the standard arm. Modified reporting reduced treatment of ASB, but without statistical significance. Modified reporting is a safe method to reduce inappropriate antibiotic treatment in long-term care facilities.

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