title: Electronic memorandum decreases unnecessary antimicrobial use for asymptomatic bacteriuria and culture-negative pyuria.
abstract: OBJECTIVE
  Asymptomatic bacteriuria/candidiuria (ASB) and culture-negative pyuria (CNP) are common and often result in inappropriate antibiotic use. We aimed to evaluate whether a standardized educational memorandum could reduce antimicrobial utilization for ASB/CNP.
  
  
  METHODS
  Quasi-experimental study with a control group, from a convenience sample of inpatients with abnormal urinalysis or urine culture results in a Veterans Affairs hospital.
  
  
  METHODS
  An educational memorandum outlining guidelines for diagnosis and treatment of ASB was placed in the chart of patients with ASB/CNP who were receiving antimicrobials.
  
  
  METHODS
  The records of patients meeting inclusion criteria were abstracted for demographics, comorbidities, antimicrobials, and symptoms suggestive of possible urinary tract infection (UTI). Patients were categorized as having ASB, CNP, or UTI. The number of antimicrobial-days attributed to ASB/CNP was compared between the control group and the intervention group.
  
  
  RESULTS
  Charts of 301 patients with abnormal urine results were reviewed. Thirty of 117 (26%) patients in the control group received antimicrobials for ASB/CNP for an average of 6.3 days. In the intervention group, 24 of 92 (26%) patients received antimicrobials for ASB/CNP for an average of 2.2 days (t-test: P < .001). Adverse events from antimicrobials for ASB/CNP occurred in 3 of the 30 (10%) patients in the control group. There were no adverse events from untreated ASB/CNP in the intervention group.
  
  
  CONCLUSIONS
  ASB and CNP resulted in antimicrobial exposure in more than one-quarter of our study patients. Placing a standardized memorandum in the electronic record was associated with a 65% relative reduction in antimicrobial-days for ASB and CNP.
authors.affiliation: Veterans Affairs Boston Health Care System, Boston, Massachusetts 02132, USA.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Linares
authors.forename: David J
authors.initials: DJ
authors.lastname: Thornton
authors.forename: Judith
authors.initials: J
authors.lastname: Strymish
authors.forename: Errol
authors.initials: E
authors.lastname: Baker
authors.forename: Kalpana
authors.initials: K
authors.lastname: Gupta
mesh_terms: D000368:Aged; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D001437:Bacteriuria / Q000188:drug therapy*; D002177:Candidiasis / Q000188:drug therapy / Q000652:urine; D004363:Drug Utilization / Q000706:statistics & numerical data; D004502:Education, Medical, Continuing; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011776:Pyuria / Q000188:drug therapy*; D058996:Quality Improvement; D017010:Reminder Systems
chemical_list: D000892:Anti-Infective Agents, Urinary