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If you don't test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuria.

Authors :
Winkler ML
Huang J
Starr J
Hooper DC
Paras ML
Letourneau AR
Shenoy ES
Source :
Antimicrobial stewardship & healthcare epidemiology : ASHE [Antimicrob Steward Healthc Epidemiol] 2023 May 26; Vol. 3 (1), pp. e95. Date of Electronic Publication: 2023 May 26 (Print Publication: 2023).
Publication Year :
2023

Abstract

Objective: Screening for asymptomatic bacteriuria (ASB) is not recommended outside of patients undergoing invasive urological procedures and during pregnancy. Despite national guidelines recommending against screening for ASB, this practice is prevalent. We present outcomes from a quality-improvement intervention targeting patients undergoing cardiac artery bypass grafting surgery (CABG) at Massachusetts General Hospital, a tertiary-care hospital in Boston, Massachusetts, where preoperative testing checklists were modified to remove routine urinalysis and urine culture. This was a before-and-after intervention study.<br />Methods: Prior to the intervention, screening for ASB was included in the preoperative check list for all patients undergoing CABG. We assessed the proportion of patients undergoing screening for ASB in the 6 months prior to and after the intervention. We estimated cost savings from averted laboratory analyses, and we evaluated changes in antibiotic prescriptions. We additionally examined the incidence of postoperative surgical-site infections (SSIs), central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs) and Clostridioides difficile infections (CDIs).<br />Results: Comparing the pre- and postintervention periods, urinalyses decreased by 76.5% and urine cultures decreased by 87.0%, with an estimated cost savings of $8,090.38. There were 50% fewer antibiotic prescriptions for bacteriuria after the intervention.<br />Conclusions: Removal of urinalysis and urine culture from preoperative checklists for cardiac surgery led to a statistically significant decrease in testing without an increase in SSIs, CLABSIs, CAUTIs, or CDI. Challenges identified included persistence of checklists in templated order sets in the electronic health record.<br />Competing Interests: All authors report no conflicts of interest relevant to this article.<br /> (© The Author(s) 2023.)

Details

Language :
English
ISSN :
2732-494X
Volume :
3
Issue :
1
Database :
MEDLINE
Journal :
Antimicrobial stewardship & healthcare epidemiology : ASHE
Publication Type :
Academic Journal
Accession number :
37256152
Full Text :
https://doi.org/10.1017/ash.2023.166