How do critical access hospitals stack up asymptomatic bacteriuria management?

Reviewed by Jen Cihlar, Vanderbilt University Medical Center

The authors of this study have described antibiotic prescribing patterns of a cohort of 17 critical access hospitals (CAH), small rural hospitals with <25 beds. The hospitals received education on UTIs and asymptomatic bacteriuria (ASB) through a tele-antimicrobial stewardship program and found they had a relatively lower prevalence of ASB at 35% (compared to previous reports of 45%–71%), though about 76% of those still received inappropriate antibiotics. They noted a higher proportion being from emergency room, patients who older age, male, had urological comorbidities or an acute mental status change. This rate of inappropriate antibiotic prescribing for ASB is not dissimilar from studies from larger, tertiary care hospitals (Spivak et al, 2017). It is important to further evaluate similarities and differences between different hospital settings to best target antimicrobial stewardship efforts.


Hartlage W, Bryson-Cahn C, Castillo AY, et al. Asymptomatic bacteriuria in critical-access hospitals: Prevalence and patient characteristics driving treatment. Infection Control & Hospital Epidemiology. 2023:1-4. doi:10.1017/ice.2023.220 Spivak ES, Burk M, Zhang R, et al. Management of Bacteriuria in Veterans Affairs Hospitals. Clin Infect Dis. 2017;65(6):910-917. doi:10.1093/cid/cix474

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