1437. Safety and Effectiveness of a Laboratory Intervention to Reduce Antibiotic Consumption in Patients with Asymptomatic Bacteriuria
Notice bibliographique
Résumé
Abstract Background Antibiotic (AB) therapy for asymptomatic bacteriuria (ASB) persists despite evidence of lack of benefit. In 2012, our hospital piloted an intervention to stop routinely reporting positive midstream urine (MSU) from inpatients since the majority of patients were asymptomatic. Following the pilot, we moved to rejecting all MSU unless a telephone request was received. We undertook the present study to establish the safety and assess the long-term impact of this change. Methods From November 2013 to April 2019, when MSU were received from surgical wards (two surgical wards added in May 2015) and medical wards (from August 2017) in our hospital, a message was posted noting that ASB should not be treated and a call to the lab was required to initiate specimen processing. Patients were interviewed, and charts were reviewed within 24h of specimen receipt and 4d later to identify urinary tract symptoms/infection (UTS/UTI) and systemic infection. Primary outcome was serious adverse events (AEs). Secondary outcomes were: rate of MSU submitted, impact on lab workload, AB use. Results 1,678 episodes with submitted MSU were included; 995/1,678 (60%) MSU cultures were not processed. Of 683 processed, 482 (71%) were negative. 1,111/1,678 (66%) patients were asymptomatic when MSU was ordered. 1,393/1,678 (83%) had negative culture (N = 482) or completed d4 follow-up (N = 911). No symptomatic UTI/sepsis/systemic infection occurred; the only AE identified were 4 patients with prolonged UTS which might have been prevented by MSU processing (4/911; 0.4% patients with AE). Rates of MSU submitted remained stable at 12 per 1,000 patient-days, P = 0.59 (Figure 1). Proportion of processed MSU decreased from 16/22, 73% in 2013 to 67/137, 49% in 2019 (Figure 2; P = 0.002). Overall, microbiology workload decreased by 5 person-days/year (fewer MSU processed, but staff needed to respond to telephone calls). 275/1,678 (16%) patients received AB for presumed UTI; 221 (80%) treated empirically, 54 (20%) in response to positive MSU. Of 69 patients with ASB whose MSU was processed and positive, 32 (46%) were prescribed antibiotics. Assuming that 21% of rejected MSU from asymptomatic patients would have been positive, AB therapy for ASB was avoided in 66 patients. Conclusion Rejecting MSU specimens does not result in harm, and reduces lab workload and AB therapy for ASB. Disclosures All authors: No reported disclosures.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».