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Overuse of Antibiotics for Asymptomatic Bacteriuria in a University Teaching Hospital

Webster, Emily C. (2013) Overuse of Antibiotics for Asymptomatic Bacteriuria in a University Teaching Hospital. Master's Thesis, University of Pittsburgh. (Unpublished)

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Public Health Significance: Antibiotic resistance is an increasingly important public health issue. Antibiotic resistance emerges from antibiotic use, and unnecessary and incorrect usage of these drugs is accelerating the increasing prevalence and severity of resistant organisms. Misdiagnosis of a urinary tract infection is one of the main causes of unnecessary antibiotic use.
Problem Statement: Antibiotic overuse can lead to adverse patient outcomes, and antibiotics should be used judiciously and according to published treatment guidelines. Many clinicians at healthcare facilities do not adhere to treatment guidelines for asymptomatic bacteriuria; often clinicians incorrectly give asymptomatic patients a diagnosis of a urinary tract infection which has been shown to yield high rates of unnecessary antibiotic use.
Objective: To determine whether the University Teaching Hospital adheres to IDSA treatment guidelines for UTI and ABU for this cohort of patients and explore the relationship between failure to adhere to IDSA guidelines of treatment of ABU and excess pharmaceutical costs.
Setting: A public acute care teaching hospital affiliated with a local state university in central Texas.
Participants: Patients included in the cohort were at least 18 years of age and admitted to the hospital for >2 days between the dates of September 2011 and February 2012 and diagnosed with a UTI.
Main outcome measures: Frequency of patients who were incorrectly diagnosed with a UTI who were asymptomatic and treated inappropriately, total number of antibiotics used for these patients, and the costs of these unnecessary antibiotics.
Results: Of the 88 included patients, 26 patients (29.5%) had no documentation of any symptoms of a UTI but were diagnosed and treated inappropriately. There were a total of 353 doses given to these patients for a total excess cost of $512.45. Eleven patients (12.5%) were classified as a “questionable” diagnosis of a UTI because documentation was not clear enough to indicate if the patient had a UTI or ABU. There were a total of 234 doses given to these patients for a total excess cost of $271.76.
Conclusion: Based upon this sample, clinicians in this facility do not strictly adhere to IDSA treatment guidelines. The clinicians could benefit from an antibiotic stewardship program or an educational intervention to improve adherence to the current IDSA guidelines.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Webster, Emily C.ecw32@pitt.eduECW32
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairFrank, Lindafrankie@pitt.eduFRANKIE
Committee MemberMartinson, Jeremy Jjmartins@pitt.eduJMARTINS
Committee MemberSkledar, SusanskledarSJ@upmc.eduSJS15
Committee MemberMuto,
Date: 27 June 2013
Date Type: Publication
Defense Date: 25 March 2013
Approval Date: 27 June 2013
Submission Date: 26 March 2013
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 85
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Infectious Diseases and Microbiology
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: antibiotics, antimicrobial, antimicrobial stewardship, bacteriuria, urinary tract infection
Date Deposited: 27 Jun 2013 18:26
Last Modified: 19 Dec 2016 14:40

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