Modified reporting of positive urine cultures to reduce treatment of catheter-associated asymptomatic bacteriuria (CA-ASB) among inpatients: a randomized controlled trial
Bibliographic record
Abstract
We conducted a randomized, unblinded superiority trial to determine if modified laboratory reporting of positive urine cultures (UC) increased the appropriateness of antibiotic treatment among catheterized inpatients. Efficacy outcome was treatment appropriateness. Safety outcomes included adverse events, bacteremia, and death. Between November 2018 and June 2019, 100 consecutive positive UCs were randomized to the standard report (SR) (bacterial count, identification and susceptibility) or modified report (MR) (standardized comment). Exclusion criteria were pregnancy, current antibiotic treatment, intensive care unit (ICU) or urology admission, or neutropenia. Current antibiotic treatment was excluded because their use may affect culture interpretation. True diagnosis of catheter-associated urinary tract infection (CA-UTI) or catheter-associated asymptomatic bacteriuria (CA-ASB) was based on published criteria and prospective chart review. Patients were followed for 7 days after reporting. Of 543 positive UC considered, 443 were excluded. The intention-to-treat (ITT) analysis included 100 UCs, while per protocol (PP) included 90. CA-ASB was diagnosed in 75% of all urines and 60% of these cases were treated with antibiotics. All CA-UTI cases were treated. There was a trend towards increased appropriate treatment (untreated CA-ASB + treated CA-UTI) in the MR than the SR: 31/54 (57.4%) vs 23/46 (50.0%), (+7.4%, p=0.45, RR=1.15) by ITT analysis. PP analysis gave similar results. There were 4/54 (7.4%) deaths and 16/54 (29.6%) adverse events in the MR, and 3/46 (6.5%) deaths and 19/46 (41.3%) adverse events in the SR (-11.7% adverse events, p=0.216). We conclude that MR trends towards treatment appropriateness and may be safe. Larger studies are required.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".