Effect of microbiology comment nudging on antibiotic use in asymptomatic bacteriuria: A before-and-after quasi-experimental study

Abstract

Objective: To describe the effect of a microbiology comment nudge on antibiotic use for asymptomatic bacteriuria (ASB). Design: Single-center, before-and-after, quasi-experimental study. Setting: Community-based, public, not-for-profit teaching hospital in the southeastern United States. Participants: Adult inpatients with a positive urine culture and the absence of urinary tract infection signs and symptoms. Intervention: Implementation of a microbiology comment nudge on urine cultures. Results: In total, 204 patients were included in the study. Antibiotics were less likely to be continued beyond 72 hours in the postimplementation group: 57 (55%) of 104 versus 38 (38%) of 100 (P =.016). They were less likely to have antibiotics continued beyond 48 hours: 60 (58%) of 104 versus 43 (43%) of 100 (P =.036). They were also less likely to have antibiotics prescribed at discharge 35 (34%) of 104 versus 20 (20%) of 100 (P =.028). In addition, they had fewer total antibiotic days of therapy: 4 (IQR, 1-6) versus 1 (IQR, 0-6) (P =.022). Conclusion: Microbiology comment nudging may contribute to less antibiotic utilization in patients with ASB.