Erratum: Implementation of an asymptomatic bacteriuria assessment protocol for patients discharged from the emergency department - CORRIGENDUM.

[This corrects the article DOI: 10.1017/ash.2023.117.].

Impact of restrictive urinalysis reflex to culture criteria at a large community hospital.

Treatment of asymptomatic bacteriuria (ASB) is a common, but often unnecessary, practice. Our objective was to determine the impact of restrictive urinalysis reflex to culture (UARC) criteria on rate of urine cultures (UC) ordered and ASB treatment. Criteria were modified from positive leukocyte esterase, positive nitrites, or white blood cells (WBC) >10 cells to only WBC >10 cells. This pre-post study evaluated UARCs ordered in the emergency department or inpatient units. The primary outcome was the proportion of reflex UCs prevented. Secondary outcomes included the frequency of repeat UARCs and stand-alone UCs, gram-negative rod (GNR) bacteremia, and ASB treatment. In the pre-intervention, there were 4761 UARCs compared to 5420 in the post-intervention; 37.9 % and 21.4 % reflexed to UCs, a 43.5 % reduction in UCs. The rate of repeat UARCs, stand-alone UCs, and GNR bacteremia in the pre- and post-interventions were similar. ASB treatment rate was numerically lower in the post-intervention.

Impact of Gram-Negative Rod Bacteremia Rapid Diagnostic Testing and Real-Time Clinical Pharmacist Intervention.

Background: The optimal method for implementing rapid diagnostic testing (RDT) into clinical practice has not been determined for gram-negative rod (GNR) bacteremia. At our institution, RDT was implemented in conjunction with real-time notification of results to decentralized clinical pharmacists. Objective: To determine the impact of RDT result notification plus real-time clinical pharmacist review on the management of GNR bacteremia. Methods: This retrospective, matched cohort study included patients with a positive blood culture for a GNR on the BIOFIRE® Blood Culture Identification 2 panel from September 2020 to August 2021 (historical) and October 2021 to September 2022 (interventional). Exclusion criteria were polymicrobial bacteremia, discrepant RDT results from traditional culture, 24-hour mortality, and comfort care or not admitted at the time of RDT result. Patients were matched based on age, pathogen, and resistance. The primary endpoint was time from Gram stain to appropriate antibiotic therapy. Results: This study consisted of 240 patients (n = 120 historical, n = 120 interventional). Escherichia coli was isolated in 71% of patients with extended-spectrum beta-lactamase-producing organisms isolated in 8%. There was no difference in median time to appropriate therapy (0 vs 0 hours, P = 0.28). There was a statistically significant decrease in time to first organism-directed change in therapy (40 vs 11 hours; P < 0.01). Length of stay, days of anti-pseudomonal therapy, and inpatient mortality did not differ between groups. Conclusion: Implementation of RDT plus real-time clinical pharmacist review did not significantly decrease time to appropriate therapy in patients with GNR bacteremia but significantly reduced time to organism-directed antibiotic changes.

Implementation of an asymptomatic bacteriuria assessment protocol for patients discharged from the emergency department.

Objective: We evaluated the impact of an asymptomatic bacteriuria (ASB) assessment protocol on the number of antibiotics prescribed for ASB after discharge from the emergency department (ED). Design: Single-center, before-and-after, retrospective cohort study. Setting: The study was conducted at a large community health system in North Carolina. Patients: Eligible patients were discharged from an ED without an antibiotic prescription and had a positive urine culture result after discharge from May through July 2021 (preimplementation group) and October through December 2021 (postimplementation group). Methods: Patient records were reviewed to determine the number of antibiotic prescriptions for ASB on follow-up call before and after implementation of an ASB assessment protocol. Secondary outcomes included 30-day admissions, 30-day ED visits, 30-day UTI-related encounters, and projected antibiotic days of therapy. Results: The study included 263 patients: 147 in the preimplementation group and 116 in the postimplementation group). There were significantly fewer antibiotic prescriptions for ASB in the postimplementation group (50% vs 87%; P < .0001). There were no differences in the incidence of 30-day admissions (7% vs 8%; P = .9761), 30-day ED visits (14% vs 16%; P = .7805), or 30-day UTI-related encounters (0% vs 0%, NA). Conclusions: Implementation of an ASB assessment protocol for patients discharged from the ED significantly reduced the number of antibiotic prescriptions for ASB on follow-up call without an increase in 30-day admissions, ED visits, or UTI-related encounters.