title: Why is asymptomatic bacteriuria overtreated?: A tertiary care institutional survey of resident physicians.
abstract: BACKGROUND
  Asymptomatic bacteriuria (ABU) is common and often leads to unnecessary antimicrobial use. Reducing antibiotic overuse for ABU is therefore an important issue for antimicrobial stewardship. We performed this study to investigate the appropriateness of ABU management and to evaluate physicians' knowledge and practice regarding ABU.
  
  
  METHODS
  We reviewed all urine cultures of ≥10(5) cfu/mL of bacteria among inpatients in a 900-bed hospital in 2011. Each episode of bacteriuria was classified into ABU or urinary tract infection (UTI). ABU was defined as a positive urine culture (≥10(5) cfu/mL) without symptoms or signs suggesting UTI. In October 2012 a cross-sectional survey of resident physicians was undertaken using an anonymous, self-administered questionnaire.
  
  
  RESULTS
  We identified 219 ABU cases among 1167 positive urine cultures, of which 70 (32.0 %) were inappropriately treated. Female gender, old age, pyuria, hematuria, and positive nitrite on urinalysis were associated with inappropriate ABU treatment in a multivariate analysis (P < 0.05). The response rate to the survey was 74.2 % (95/128). The mean knowledge score was 37.3 %, and 33.7 % of respondents were able to distinguish ABU from UTI, but less than half knew the indications for treating ABU. Even after ABU was correctly diagnosed, concerns about postoperative infections (38.6 %), UTI (9.1 %), and abnormal urinalysis (29.5 %) prevented proper management. About half of the respondents reported to prescribing antibiotics for ABU despite knowing they were not indicated.
  
  
  CONCLUSIONS
  About one third of ABUs were inappropriately managed. Lack of knowledge and discrepancies between knowledge and practice, contributed to antimicrobial overuse for ABU. Our findings highlight the importance of developing interventions, including education, audit and feedback, to tackle the problem of inappropriate treatment of ABU.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. mjinnie@naver.com.
authors.forename: Myung Jin
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. moonsuk0725@gmail.com.
authors.forename: Moonsuk
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. NH.Kim.MD@gmail.com.
authors.forename: Nak-Hyun
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. erinus00@gmail.com.|Department of Internal Medicine, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea. erinus00@gmail.com.
authors.forename: Chung-Jong
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. khsongmd@gmail.com.|Department of Internal Medicine, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea. khsongmd@gmail.com.
authors.forename: Kyoung-Ho
authors.initials: KH
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. pgchoe@gmail.com.
authors.forename: Pyoeng Gyun
authors.initials: PG
authors.lastname: Choe
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. wbpark1@snu.ac.kr.
authors.forename: Wan Beom
authors.initials: WB
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. roundbirch@gmail.com.
authors.forename: Ji Hwan
authors.initials: JH
authors.lastname: Bang
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. yonathan@hanafos.com.|Department of Internal Medicine, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea. yonathan@hanafos.com.
authors.forename: Eu Suk
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. hswon1@snu.ac.kr.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. molder@unitel.co.kr.
authors.forename: Nam Joong
authors.initials: NJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. mdohmd@snu.ac.kr.
authors.forename: Myoung-Don
authors.initials: MD
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. hbkimmd@snu.ac.kr.|Department of Internal Medicine, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Republic of Korea. hbkimmd@snu.ac.kr.
authors.forename: Hong Bin
authors.initials: HB
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001437:Bacteriuria / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D063128:Tertiary Health Care / Q000706:statistics & numerical data; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents