The authors of a related commentary note that the intervention was targeted to the clinicians who were primarily responsible for ordering urine cultures. Several components of the intervention targeted education and feedback – including development and use of a simple diagnostic and treatment algorithm for the evaluation of catheter-associated UTI, individualised audit and feedback of diagnostic and treatment decisions, workshops for long-term care personnel, and enhanced education efforts for units with high rates of urine culture ordering.
The rate of urine cultures ordered decreased from 41.2 to 23.3 per 1000 bed-days from baseline to the intervention period, and further to 12.0 per 1000 bed-days during the maintenance period. Rates of asymptomatic bacteriuria (ASB) treatment decreased from 1.6 to 0.6 to 0.4 per 1000 bed-days, respectively. The most significant change in treatment practices was observed on the long-term care wards.
The comment notes that the study did not look at the overall rate of antimicrobial prescribing, so any changes in this are unknown. In addition the rate of ASB overtreatment at the comparison (control) site was low at baseline – and it is unknown if the intervention would have the same benefits in such centres. This intervention required significant personnel time and training, which may not be available at all centres.