If you don't test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuria

Marisa L Winkler; Joanne Huang; Jessica Starr; David C Hooper; Molly L Paras; Alyssa R Letourneau; Erica S Shenoy

doi:10.1017/ash.2023.166

If you don't test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuria

Antimicrob Steward Healthc Epidemiol. 2023 May 26;3(1):e95. doi: 10.1017/ash.2023.166. eCollection 2023.

Authors

Marisa L Winkler^{1

2

3

4}, Joanne Huang⁵, Jessica Starr⁶, David C Hooper^{1

2

4}, Molly L Paras^{1

2}, Alyssa R Letourneau^{1

2}, Erica S Shenoy^{1

2

4}

Affiliations

¹ Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts.
² Department of Medicine, Harvard Medical School, Boston, Massachusetts.
³ Department of Microbiology, Brigham and Women's Hospital, Boston, Massachusetts.
⁴ Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts.
⁵ Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts.
⁶ Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.

Abstract

Objective: Screening for asymptomatic bacteriuria (ASB) is not recommended outside of patients undergoing invasive urological procedures and during pregnancy. Despite national guidelines recommending against screening for ASB, this practice is prevalent. We present outcomes from a quality-improvement intervention targeting patients undergoing cardiac artery bypass grafting surgery (CABG) at Massachusetts General Hospital, a tertiary-care hospital in Boston, Massachusetts, where preoperative testing checklists were modified to remove routine urinalysis and urine culture. This was a before-and-after intervention study.

Methods: Prior to the intervention, screening for ASB was included in the preoperative check list for all patients undergoing CABG. We assessed the proportion of patients undergoing screening for ASB in the 6 months prior to and after the intervention. We estimated cost savings from averted laboratory analyses, and we evaluated changes in antibiotic prescriptions. We additionally examined the incidence of postoperative surgical-site infections (SSIs), central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs) and Clostridioides difficile infections (CDIs).

Results: Comparing the pre- and postintervention periods, urinalyses decreased by 76.5% and urine cultures decreased by 87.0%, with an estimated cost savings of $8,090.38. There were 50% fewer antibiotic prescriptions for bacteriuria after the intervention.

Conclusions: Removal of urinalysis and urine culture from preoperative checklists for cardiac surgery led to a statistically significant decrease in testing without an increase in SSIs, CLABSIs, CAUTIs, or CDI. Challenges identified included persistence of checklists in templated order sets in the electronic health record.