# De-Implementing Testing and Treating of Urine Cultures in Asymptomatic Patients

> **NIH VA I01** · VA BOSTON HEALTH CARE SYSTEM · 2024 · —

## Abstract

Background: Successful deployment of strategies to reduce unnecessary testing and treatment is a critical
component of improving care and minimizing harms. The Choosing Wisely Initiative has highlighted the
importance of safely and effectively de-implementing unnecessary testing and treating practices. Positive urine
cultures are a major driver of inappropriate antimicrobial use. Asymptomatic patients are often screened and
positive urine cultures treated, despite new guidelines from national societies that patients without symptoms of
urinary tract infection (UTI) should not have a urine culture performed and should not be treated with antibiotics
even if the culture is positive. This inappropriate use of antibiotics can lead to preventable patient harms (e.g.,
C. difficile infection, antibiotic resistance) without any benefit. This proposal will develop and test a de-
implementation strategy for reducing screening and treatment of urine cultures in asymptomatic surgical
patients.
Specific Aims: Aim 1: Develop a live database of the 15-facility CDC-CREATE Network to identify and to
track organizational, provider, and patient level factors associated with preoperative urine testing and ASB
treatment. Aim 2: Determine the current context of pre-operative urine testing and treating, and barriers and
facilitators to de-implementation, using in-depth interviews at 5 facilities in our CDC-CREATE network. Aim 3:
Develop a de-implementation tool and randomly select 5 intervention sites for pilot testing and compare rates
of urine testing in 5 randomly selected control sites using time series analysis.
Significance: This proposal meets the HSR&D Implementation Science priority area that addresses provider
behavior and Secretary Shulkin's Priority 3: Focus Resources More Efficiently. It also addresses the Infectious
Diseases Society of America #1 Choosing Wisely recommendation which says, “Don't treat asymptomatic
bacteriuria with antibiotics.” The impact on Veteran's healthcare will be to focus resources towards evidence
based practices that are associated with benefits (surgical prevention checklist) and away from potentially
harmful practices (urine testing and treatment in asymptomatic patients). This innovative approach will
translate new guidelines - to do less - into action using a theory based multi-pronged intervention.
Methods: We will partner with the De-implementation Quality Enhancement Research Initiative (QUERI) and
adapt their conceptual framework to achieve the proposal objectives. In addition, we will utilize our existing
partnership with the CDC-CREATE network of sites to evaluate the context, facilitators and barriers to stopping
urine culture practices in asymptomatic surgical patients and to pilot test a de-implementation strategy. We will
use a mixed-methods approach, including analyses of data from the national VA databases (e.g. Corporate
Data Warehouse), qualitative interviews, and piloting of a de-implementation strategy with a ...

## Key facts

- **NIH application ID:** 10862552
- **Project number:** 5I01HX002695-04
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** Marin Leigh Schweizer
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-12-01 → 2023-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10862552

## Citation

> US National Institutes of Health, RePORTER application 10862552, De-Implementing Testing and Treating of Urine Cultures in Asymptomatic Patients (5I01HX002695-04). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10862552. Licensed CC0.

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