Urinary tract infection (UTI) is one of the most common infections for which antimicrobials are prescribed. In the event of asymptomatic bacteriuria (ASB), antimicrobial prescriptions are not always necessary. The aim of this project is to reduce the overtreatment of ASB by using a multifaceted de-implementation strategy.

Asymptomatic bacteriuria (ASB) is the presence of bacteria in the urine of a patient, who does not have symptoms of UTI. ASB is a common finding, especially among women, elderly persons, and patients with urinary catheters. Both international and national guidelines strongly recommend not to screen for or treat ASB with antimicrobials, except for patients at risk of developing a complicated UTI. The results of earlier studies showed that this inappropriate treatment has a prevalence of 45%. With regard to international guidelines and antimicrobial stewardship, successful multifaceted interventions showed a decrease in overtreatment of ASB. However, effectiveness studies are not yet performed in emergency departments. We will use a stepped wedge cluster randomized design for our multifaceted de-implementation strategy, comparing outcomes before and after introduction of our intervention in the emergency department of five hospitals (clusters) in the Netherlands. The de-implementation strategy consists of a combination of interventions, such as education, audit and feedback. All patients (≥ 18 years old) who had a urine test while presented at the emergency department will be screened for eligibility. The primary endpoint is overtreatment of ASB without risk factors (e.g. pregnancy, planned invasive urologic procedures and neutropenia). Secondary endpoints are the duration of antimicrobial treatment for ASB, the number of urine cultures per 1000 patients, the number of urinalyses, and overtreatment of positive urinalysis in asymptomatic patients. The aim of our project is to reduce inappropriate screening and treatment of ASB in emergency departments by 50%.

Contact information

Tessa van Horrik,
Prof.dr. Suzanne Geerlings,

Researchers involved

Project group: T.M.Z.X.K. van Horrik1, B.J. Laan1, and prof. dr. S.E. Geerlings1.
Other investigators: dr. J.E. Stalenhoef2, dr. C. van Nieuwkoop3, J.B. Saanen4, dr. C. Schneeberger-van der Linden5.

  1. Amsterdam UMC, University of Amsterdam, Internal Medicine, Infectious Diseases, Amsterdam, Netherlands
  2. OLVG, Internal Medicine, Infectious Diseases, Amsterdam, Netherlands
  3. Haga Teaching Hospital, Internal Medicine, Infectious Diseases, The Hague, Netherlands
  4. Amsterdam UMC, University of Amsterdam, Emergency Medicine, Amsterdam, Netherlands
  5. Amsterdam UMC, University of Amsterdam, Medical Microbiology, Amsterdam, Netherlands