September 16, 2021
Antimicrobial Stewardship is a practice that promotes appropriate antibiotic use and eliminates routine urine testing.
Story by Shane Westin | Photo by Leah Hennel
Improper use of antibiotics is making bacterial infections more difficult to treat. In fact, antibiotic resistance is one of the gravest health threats in the world today, according to Dr. Theresa Tam, Canada’s Chief Public Health Officer.
Although eclipsed by the COVID-19 pandemic at present, this reality is not lost on the people behind a special team at Alberta Health Services’ (AHS) — the Appropriateness and Stewardship in Asymptomatic Bacteriuria (ASAB) Working Group — led by infectious disease specialist Dr. Lynora Saxinger and medical microbiology specialist Dr. Michael Groeschel.
They know that the over-prescribing of antibiotics occurs far too often as a result of routine testing for Urinary Tract Infection (UTI), even in the absence of symptoms of UTI — a situation they describe as ‘treating the urine rather than the patient’.
“Anytime we sample urine we might find bacteria that are not doing anything in particular to the patient,” says Dr. Saxinger. “Asymptomatic bacteriuria is very common, especially in elderly people and people with catheters; antibiotic overuse for those patients is also very common and has no benefit for the patient. It can cause more harm than good.”
Exposing patients to antibiotics not only increases the risk of bacteria developing resistance, but also increases the chances of other negative outcomes of antibiotic therapy such as C. difficile infections and adverse or allergic reactions.
Here’s where Antimicrobial Stewardship enters the picture — a practice that promotes appropriate antibiotic use, in this case by eliminating routine urine testing.
An Antimicrobial Stewardship project – Appropriateness and Stewardship in Asymptomatic Bacteriuria – falls under the umbrella of a larger AHS program — Right Care Alberta — which focuses on clinical appropriateness and shared decision making. It helps patients, families and healthcare providers choose and use quality health services that are evidence-based, necessary, person-centred, safe and respectful — while providing the most appropriate services and treatments to patients based on their own voice and values.
A recent study at the Foothills Medical Centre (FMC) Emergency Department (ED) found that nearly 45 per cent of patients with positive urine cultures had no symptoms of UTI. And with 750,000 urine cultures processed in Alberta annually, it’s easy to imagine how this impacts antibiotic resistance.
Since 2018, the ASAB Working Group, with the support of a greater Steering Committee and in tandem with the Physician Learning Program, has led the development and distribution of adult clinical decision tools and information. Dr. Shawn Dowling, lead at FMC ED, used them to implement the ASAB initiative and create awareness of the problem.
“We achieved a 17-per-cent relative reduction in urine culture orders after we provided ASAB tools, information and education,” says Dr. Dowling. “Audits have shown, that with some additional interventions, we could achieve an even greater reduction.”
Working with site champions, the ASAB Working Group introduced the initiative to South Health Campus seeing similar benefit in a sustained 20 per cent relative reduction in urine culture orders. The ASAB Working Group continues to explore additional opportunities to grow the program throughout the healthcare spectrum, from acute and primary care to long-term care and supportive living facilities. The work is also spreading across the continent with requests to use materials coming from health jurisdictions in Michigan, New York and Pennsylvania.