Overtreatment of asymptomatic bacteriuria: a qualitative study

Eyer, Myriam Marcelle; Läng, M; Aujesky, Drahomir; Marschall, Jonas (2016). Overtreatment of asymptomatic bacteriuria: a qualitative study. Journal of hospital infection, 93(3), pp. 297-303. Elsevier 10.1016/j.jhin.2016.04.007

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BACKGROUND Overtreatment of asymptomatic bacteriuria (ASB) is widespread and may result in antibiotic side-effects, excess costs to the healthcare system, and may potentially trigger antimicrobial resistance. According to international management guidelines, ASB is not an indication for antibiotic treatment (with few exceptions). AIM To determine reasons for using antibiotics to treat ASB in the absence of a treatment indication. METHODS A qualitative study was conducted at a tertiary care hospital in Switzerland during 2011. We interviewed 21 internal medicine residents and attending physicians selected by purposive sampling, using a semi-structured questionnaire. Responses were analysed in an inductive thematic content approach using dedicated software (MAXQDA(®)). FINDINGS In the 21 interviews, the following thematic rationales for antibiotic overtreatment of ASB were reported (in order of reporting frequency): (i) treating laboratory findings without taking the clinical picture into account (N = 17); (ii) psychological factors such as anxiety, overcautiousness, or anticipated positive impact on patient outcomes (N = 13); (iii) external pressors such as institutional culture, peer pressure, patient expectation, and excessive workload that interferes with proper decision-making (N = 9); (iv) difficulty with interpreting clinical signs and symptoms (N = 8). CONCLUSION In this qualitative study we identified both physician-centred factors (e.g. overcautiousness) and external pressors (e.g. excessive workload) as motivators for prescribing unnecessary antibiotics. Also, we interpreted the frequently cited practice of treating asymptomatic patients based on laboratory findings alone as lack of awareness of evidence-based best practices.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Eyer, Myriam Marcelle; Aujesky, Drahomir and Marschall, Jonas

Subjects:

500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health

ISSN:

0195-6701

Publisher:

Elsevier

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

13 Jul 2016 08:05

Last Modified:

05 Apr 2017 08:11

Publisher DOI:

10.1016/j.jhin.2016.04.007

PubMed ID:

27174231

Uncontrolled Keywords:

Asymptomatic bacteriuria; Overtreatment; Qualitative research; Urinary tract infection

BORIS DOI:

10.7892/boris.82531

URI:

https://boris.unibe.ch/id/eprint/82531

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