Houston Health Department

Asymptomatic Bacteriuria — A Community Case Study

The Houston Health Department has made it a priority to address antibiotic resistance and stewardship by working collaboratively with members of the healthcare community.

In conjunction with infectious diseases experts from the Houston Health Department, the Antimicrobial Stewardship Executive Committee formed a joint learning collaborative in 2017-2018 to work on an asymptomatic bacteriuria stewardship project.

Asymptomatic Bacteriuria (ASB) is one of the most common reasons for inappropriate antibiotic use in hospitalized patients. Treatment itself may be associated with subsequent antimicrobial resistance, adverse drug effects, and cost.

The goal of the project was to engage with healthcare professionals across facilities within the Houston area to work collaboratively to help reduce unnecessary testing and treatment of ASB. The project was guided by Dr. Barbara Trautner as the subject matter expert who provided case-based feedback and intervention tools which include the “Kicking UTI” algorithm.

Participating facilities included:

Project Lead Site  
Susan Loughlin, PharmD, BCPS TIRR – Memorial Hermann  
Ardath Mitchell, PharmD, BCPS, RN Memorial Hermann — Katy Hospital  
Shimeka Edwards, PharmD Memorial Hermann Rehabilitation Hospital — Katy  
Christy Su, PharmD, BCPS Memorial Hermann Greater Heights  
Punit J. Shah, PharmD, BCPS Houston Methodist Sugarland  
Nancy N. Vuong, PharmD, MBIOT, BCPS Memorial Hermann Memorial City Medical Center  
Chris Huls, PharmD, BCPS Houston Methodist West  
Shivani Patel, PharmD, BCPS Memorial Hermann Southwest Hospital  

Pre-project ASB treatment rates were 61% and post-project ASB treatment rates were 24% (for three of the sites), representing a 37% decrease in ASB treatment. In addition, two health systems that participated in the study utilized the information obtained from the project to work with their laboratory departments to change testing practices by increasing the threshold of urine white blood cells required in the sample before reflex to testing for the presence of bacteria.