ArticleTherapeutic advances in infectious disease
De-implementation strategy to reduce overtreatment of asymptomatic bacteriuria in the emergency department: a stepped-wedge cluster randomised trial.
Article in Therapeutic advances in infectious disease. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
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4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A systematic review and meta-analysis to identify behavioural content and active ingredients of antimicrobial stewardship education and training interventions in hospital-based care settings.Antimicrobial resistance and infection control · 2025Pooled it
- De-implementation of unnecessary antibiotic use for upper respiratory tract infections in ambulatory HIV care in Mozambique: a two-arm parallel cluster-randomized controlled hybrid type II trial.Implementation science communications · 2026Article
- Article
- Advancements in urinary tract infections: understanding, prevention, diagnosis, and treatment.Therapeutic advances in infectious diseaseArticle
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8 authors.
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Abstract
Background: Asymptomatic bacteriuria (ASB) is the presence of bacteria in the urine of patients without symptoms of a urinary tract infection. Generally, treating ASB is not beneficial. Objective: We aimed to reduce overtreatment of ASB in the emergency department (ED) through a multifaceted de-implementation strategy. Design: A stepped-wedge cluster randomised trial. Methods: We performed our study in five EDs in the Netherlands from December 2020 to December 2021. Adult patients with urine cultures obtained during ED presentation were screened for inclusion and we excluded patients with indications for antibiotic therapy. The de-implementation strategy included education, reminders and competitive feedback on baseline results. The primary endpoint was patients with ASB treated with antibiotics. Secondary endpoints included the treatment duration and the number of urine tests ordered (urinalyses and urine cultures) in the ED per 1000 adult patients. Results: In total, 6837 urine cultures were screened. ASB was present in 224/3289 (7%) and 201/3548 (6%) patients, from whom 65/224 (29%) and 46/201 (23%) were inappropriately treated with antibiotics in the baseline and intervention period, respectively (adjusted odds ratio 1.20, 95% CI 0.56-2.62, Conclusion: Diagnostic stewardship by our de-implementation strategy reduced the number of urinalyses ordered and treatment duration in the ED, but we found no significant reduction in overtreatment of ASB. Trial registration: The trial was registered at https://onderzoekmetmensen.nl/en/trial/25918, on 17-12-2019, registration number NL8242. The first participants were enrolled on 01-12-2020.
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