Implementation of a novel scoring tool for urine culturing was associated with a more than 30% reduction in urinary antibiotic prescribing at a rehabilitation facility for long-term care (LTC) patients in Canada, researchers reported today in Infection Control & Hospital Epidemiology.
The aptly named BLADDER score was developed by clinicians at a 134-bed complex-continuing-care and rehabilitation facility in Ontario to promote more appropriate urine culturing in non-catheterized patients with presumed urinary tract infections (UTIs). Each of the letters in the score represents a possible symptom representative of UTI (B, blood in urine; L, loss of urinary control or incontinence; A, abdominal or flank pain; D, dysuria or pain on urination; E, elevated temperature or fever; R, repeated urination or frequency), with 1 point given for each letter in the algorithm; a score below 2 suggests careful monitoring of patient symptoms rather than a urine culture.
To evaluate the impact of the scoring tool, researchers compared urine culturing, urinary antibiotic use and length of stay (LOS), acute-care transfers, and mortality 18 months before and 16 months after the intervention.
32% decline in urinary antibiotic prescribing
Before the intervention, the mean rate of urine culturing was 12.47 cultures per 1,000 patient-days; after the intervention, the rate was 7.92 cultures per 1,000 patient-days (incidence rate ratio (IRR), 0.87; 95% confidence interval [CI], 0.67 to 1.12). Although the decline in urine culturing was not considered statistically significant, urinary antibiotic use declined significantly after the intervention, from a mean of 40.55 defined daily doses (DDD) per 1,000 patient-days before to 25.96 DDD per 1,000 patient-days after the intervention (IRR, 0.68; 95% CI, 0.59 to 0.79). There was no change in mean patient LOS, acute-care transfers, or mortality.
“The implementation of a scoring tool may be a useful adjunct to further explore in addition to other diagnostic stewardship strategies in hospitalized and LTC patients,” the study authors wrote. “Such a tool may be particularly useful as part of electronic health records as a trigger to consider more judicious culturing practices.”
