Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 143 No. 2122 (2013)

Reduction of urinary catheter use and prescription of antibiotics for asymptomatic bacteriuria in hospitalised patients in internal medicine

  • Martin Egger
  • Florian Balmer
  • Heidi Friedli-Wüthrich
  • Kathrin Mühlemann
Cite this as:
Swiss Med Wkly. 2013;143:w13796


PRINCIPLES: Unnecessary treatment of asymptomatic bacteriuria and overuse of urinary catheters in hospitals are of concern regarding antimicrobial resistance and patient safety, respectively. We investigated the effectiveness of a multifaceted intervention in reducing urinary catheter use and unnecessary prescription of antibiotics for asymptomatic bacteriuria in hospitalised patients in a clinic for internal medicine.

METHODS: Data were collected retrospectively from all inpatients during a 3-month period both before and after a multifaceted intervention from the Clinic for Internal Medicine of our secondary care hospital. The intervention consisted of implementation of guidelines, establishment of a standard for urinary catheter management, introduction of restricted orders and a reminder of indwelling catheters, as well as lectures and internet-based learning focusing on asymptomatic bacteriuria.

RESULTS: The incidence rate of urinary catheter days decreased significantly from 27 to 17 catheter days per 100 patient days (incidence rate ratio 0.61, 95% confidence interval 0.57–0.67). The incidence rate of unnecessary antibiotic treatment days for asymptomatic bacteriuria dropped significantly from 22 to 10 treatment days per 1,000 patient days (incidence rate ratio 0.46, 95% confidence interval 0.33–0.63).

CONCLUSIONS: A multifaceted intervention was effective in reducing both urinary catheter days and inappropriate antibiotic use for asymptomatic bacteriuria.


  1. Gordts B, Vrijens F, Hultstaert F, Devriese S, Van de Sande S. The 2007 Belgian national prevalence survey for hospital-acquired infections. J Hosp Infect. 2010;75:163–7.
  2. Klevens RM, Edward JR, Richards CL, Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Reports. 2007;122:160–6.
  3. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011;32:101–14.
  4. Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:625–63.
  5. Gross PA, Patel B. Reducing antibiotic overuse: A call for a national performance measure for not treating asymptomatic bacteriuria. Clin Infect Dis. 2007;45:1335–7.
  6. Cornia PB, Lipsky BA. Indwelling urinary catheters in hospitalized patients: When in doubt, pull it out. Infect Control Hosp Epidemiol. 2008;29:820–2.
  7. Cope M, Cevallos ME, Calde RM, Darouiche RO, Musher DM, Trautner BW. Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital. Clin Infect Dis. 2009;48:1182–8.
  8. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40:643–54.
  9. Nicolle LE. Urinary tract infection in long-term-care facility residents. Clin Infect Dis. 2000;31:757–61.
  10. Pfaller MA, Segreti J. Overview of the epidemiological profile and laboratory detection of extended-spectrum beta-lactamases. Clin Infect Dis. 2006;42:S143–53.
  11. McCabe WR, Jackson GG. Gram-negative bacteremia. Arch Intern Med. 1962;110:847–55.
  12. Fakih MG, Dueweke C, Meisner S, Berriel-Cass D, Savoy-Moore R, Brach N, et al. Effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheterization in hospitalized patients. Infect Control Hosp Epidemiol. 2008;29:815–9.
  13. Apisarnthanarak A, Thongphubeth K, Sirinvaravong S, Kitkangvan D, Yuekyen C, Warachan B, et al. Effectiveness of multifaceted hospitalwide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care center in Thailand. Infect Control Hosp Epidemiol. 2007;28:791–8.
  14. Topal J, Conklin S, Camp K, Morris V, Balcezak T, Herbert P. Prevention of nosocomial catheter-associated urinary tract infections through computerized feedback to physicians and a nurse-directed protocol. Am J Med Qual. 2005;20:121–6.
  15. Loeb M, Hunt D, O’Halloran K, Carusone SC, Dafoe N, Walter SD. Stop orders to reduce inappropriate urinary catheterization in hospitalized patients: a randomized controlled trial. J Gen Intern Med. 2008;23:816–20.
  16. Huang WC, Wann SR, Lin SL, Kunin CM, Kung MH, LinCH, et al. Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol. 2004;25;974–8.
  17. Meddings J, Rogers MAM, Macy M, Saint S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis. 2010;51:550–60.
  18. Knoll BM, Wright D, Ellingson L, Kraemer L, Patire R, Kuskowski MA, et al. Reduction of inappropriate urinary catheter use at a Veterans Affairs Hospital through a multifaceted quality improvement project. Clin Infect Dis. 2011;52:1283–90.
  19. Crouzet J, Bertrand X, Venier AG, Badoz M, Husson C, Talon D. Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection. J Hosp Infect. 2007;67:253–7.
  20. Cornia PB, Amory JK, Fraser S, Saint S, Lipsky BA. Computer-based order entry decreases duration of indwelling urinary catheterization in hospitalized patients. Am J Med. 2003;114:404–7.
  21. Loeb M, Simor AE, Landry L, Walter S, McArthur M, Duffy J, et al. Antibiotic use in Ontario facilities that provide chronic care. J Gen Intern Med. 2001;16:376–83.
  22. Zabarsky TF, Sethi AK, Donskey CJ. Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention. Am J Infect Control. 2008;36:476–80.
  23. Stéphan F, Sax H, Wachsmuth M, Hoffmeyer P, Clergue F, Pittet D. Reduction of urinary tract infection and antibiotic use after surgery: A controlled, prospective, before-after intervention study. Clin Infect Dis. 2006;42:1544–51.
  24. Bouza E, San Juan R, Muñoz P, Voss A, Kluytmans J on behalf of the Co-operative Group of the European Study Group on Nosocomial Infections (ESGNI). A European perspective on nosocomial urinary tract infections II. Report in incidence, clinical characteristics and outcome (ESGNI-004 study). Clin Microbiol Infect. 2001;7:532–42.

Most read articles by the same author(s)