Asymptomatic bacteriuria can be successfully managed without unnecessary antibiotic treatment, suggests an implementation guide published December 11, 2017, in JAMA Internal Medicine. Asymptomatic bacteriuria is condition in which large numbers of bacteria are present in a patient's urine, but symptoms do not exist. The researchers point to several studies of various formats and conclude that the evidence supports reducing inappropriate antimicrobial use "to improve patient outcomes and experience while reducing costs." They also point to literature emphasizing the harms of unnecessary antibiotic use, such as resistance, adverse effects and reactions, and increased healthcare costs. The researchers present an implementation guide that recommends the following: create a multidisciplinary quality improvement team backed by leadership support; educate staff regarding appropriate treatment and testing; measure and share data in real time; consider introducing an extra step for the practitioner to obtain routine urine test results; and create and implement clinical decision tools and protocols.

HRC Recommends: Antimicrobial stewardship is a major quality-of-care and patient-safety issue. The goal of an antimicrobial stewardship program should be to improve prescribing practices and reduce the emergence of antibiotic-resistant organisms. Organizations and providers should be mindful when prescribing antibiotics to ensure that they are being prescribed only because they will improve the patient's health, not simply to satisfy the patient's request for an antibiotic.