Overtreatment of asymptomatic bacteriuria: identifying provider barriers to evidence-based care.
BACKGROUND
Inappropriate use of antibiotics to treat asymptomatic bacteriuria (ASB) is a significant contributor to antibiotic overuse in hospitalized patients despite evidence-based guidelines on ASB management. We surveyed whether accurate knowledge of how to manage catheter-associated urine cultures was associated with level of training, familiarity with ASB guidelines, and various cognitive-behavioral constructs.


METHODS
We used a survey to measure respondents' knowledge of how to manage catheter-associated bacteriuria, familiarity with the content of the relevant Infectious Diseases Society of America guidelines, and cognitive-behavioral constructs. The survey was administered to 169 residents and staff providers.


RESULTS
The mean knowledge score was 57.5%, or slightly over one-half of the questions answered correctly. The overall knowledge score improved significantly with level of training (P < .0001). Only 42% of respondents reported greater than minimal recall of ASB guideline contents. Self-efficacy, behavior, risk perceptions, social norms, and guideline familiarity were individually correlated with knowledge score (P < .01). In multivariable analysis, behavior, risk perception, and year of training were correlated with knowledge score (P < .05).


CONCLUSIONS
Knowledge of how to manage catheter-associated bacteriuria according to evidence-based guidelines increases with experience. Addressing both knowledge gaps and relevant cognitive biases early in training may decrease the inappropriate use of antibiotics to treat ASB.
Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX. Electronic address: trautner@bcm.edu.
Barbara W
BW
Trautner
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX.
Nancy J
NJ
Petersen
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX.
Sylvia J
SJ
Hysong
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX.
Deborah
D
Horwitz
Southeast Louisiana Veterans Health Care System, New Orleans, LA; Section of General Internal Medicine and Geriatrics, Department of Medicine, Tulane University School of Medicine, New Orleans, LA.
P Adam
PA
Kelly
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Section of Geriatrics, Department of Medicine, Baylor College of Medicine, Houston, TX.
Aanand D
AD
Naik
D058345:Asymptomatic Infections; D001437:Bacteriuria / Q000188:drug therapy* / Q000382:microbiology; D055499:Catheter-Related Infections / Q000188:drug therapy* / Q000382:microbiology; D002983:Clinical Competence; D004501:Education, Medical; D004522:Educational Status; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D057970:Inappropriate Prescribing / Q000523:psychology; D010820:Physicians / Q000523:psychology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D020377:Self Efficacy; D066262:Social Norms; D011795:Surveys and Questionnaires; D062885:Urinary Catheters / Q000009:adverse effects
Clinical practice guidelines; Medical education; Urinary catheterization; Urinary tract infection