IDWEEK 2015 POSTER ABSTRACTS 164. Overtreatment of Asymptomatic Bacteriuria: A Qualitative Study Myriam Eyer, MD1,2; Matthias Läng, MD1; Drahomir Aujesky, MD3; Jonas Marschall, MD1; 1Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland; 2Division of Infectious Diseases, Valais Hospital, Sion, Switzerland; 3 Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland Session: 42. Antimicrobial Stewardship: Current State and Future Opportunities Thursday, October 8, 2015: 12:30 PM Background. Overtreatment of asymptomatic bacteriuria (ASB) is common and can result in antibiotic side effects, excess costs to the healthcare system, and potentially trigger antimicrobial resistance. According to international management guidelines, ASB is not an indication for antibiotic treatment (with few exceptions). Our objective
was to determine reasons for using antibiotics to treat ASB in the absence of a treatment indication. Methods. We conducted a qualitative study 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 analyzed in an inductive thematic content approach using dedicated software (MAXQDA). Results. In the 21 interviews, the following thematic rationales for antibiotic overtreatment of ASB were reported (in order of reporting frequency): (1) Treating laboratory findings without taking the clinical picture into account (n = 17); (2) Psychological factors such as anxiousness, overcautiousness or anticipated positive impact on patient outcomes (n = 13); (3) External pressors such as institutional culture, peer pressure, patient expectation, and excessive workload that interferes with proper decision-making (n = 9); 4) Difficulty with interpreting clinical signs and symptoms (n = 8). Conclusion. In this qualitative study we identified both physician-centered 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. Disclosures. All authors: No reported disclosures.
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Open Forum Infectious Diseases 2015;2:71–536 © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/ by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact [email protected]. DOI: 10.1093/ofid/ofv133
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was to determine reasons for using antibiotics to treat ASB in the absence of a treatment indication. Methods. We conducted a qualitative study 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 analyzed in an inductive thematic content approach using dedicated software (MAXQDA). Results. In the 21 interviews, the following thematic rationales for antibiotic overtreatment of ASB were reported (in order of reporting frequency): (1) Treating laboratory findings without taking the clinical picture into account (n = 17); (2) Psychological factors such as anxiousness, overcautiousness or anticipated positive impact on patient outcomes (n = 13); (3) External pressors such as institutional culture, peer pressure, patient expectation, and excessive workload that interferes with proper decision-making (n = 9); 4) Difficulty with interpreting clinical signs and symptoms (n = 8). Conclusion. In this qualitative study we identified both physician-centered 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. Disclosures. All authors: No reported disclosures.
Downloaded from http://ofid.oxfordjournals.org/ by guest on June 3, 2016
Open Forum Infectious Diseases 2015;2:71–536 © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/ by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact [email protected]. DOI: 10.1093/ofid/ofv133
Poster Abstracts
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OFID 2015:2 (Suppl 1)
•
S71
