# Less is More: Improving Antimicrobial Stewardship for Asymptomatic Bacteriuria

> **NIH VA I01** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2020 · —

## Abstract

Project Background/Rationale: Antimicrobial stewardship as a means to combat the spread of antibiotic-
resistant bacteria has become a national priority, both within and outside the VHA. This IIR project focuses on
improving Veteran safety by reducing inappropriate use of antimicrobials for asymptomatic bacteriuria (ASB), a
very common condition that leads to antimicrobial overuse in acute and long-term care. We conducted a
successful intervention to decrease guideline-discordant ordering of urine cultures and antibiotics for ASB. This
single site intervention, entitled “Kicking Catheter Associated Urinary Tract Infection (CAUTI): the No Knee-
Jerk Antibiotics Campaign,” reduced unnecessary screening for ASB by 71% and unnecessary treatment of
ASB by 75% in a large and complex VA medical center. The UTI medication use evaluation recently conducted
by the VA Antimicrobial Stewardship Task Force (ASTF) shows an acute need for our intervention, as 57% of
1,219 urine cultures treated as UTI (with antibiotics) were actually ASB. Our work is innovative in that we
address the cognitive biases that drive overuse of antibiotics and encourage more deliberate choice. Project
Objectives: The objective of this project is to facilitate implementation of a scalable version of the Kicking
CAUTI campaign across four geographically diverse VA facilities while assessing what aspects of an
antimicrobial stewardship intervention are essential to success and sustainability. Our project team and our
operational partners will provide expertise and external facilitation, while intervention implementation at the
facility level will be performed by the local personnel tasked with antimicrobial stewardship. The two main
intervention tools are (1) an evidence-based algorithm that distills the guidelines into a streamlined clinical
pathway, and (2) case-based audit and feedback to train clinicians to use the algorithm. The intervention is
directed at providers in acute and long-term care, and the goal is to reduce inappropriate screening for and
treatment of ASB in all patients and residents, not just those with urinary catheters. Aim 1 is to determine
barriers to guideline-recommended practices for management of catheter-associated bacteriuria at intervention
sites and assemble the local implementation teams. Aim 2 is to implement and evaluate a scalable version of
the Kicking CAUTI intervention in four VA facilities, using four additional sites as contemporaneous controls.
2a: We will measure the clinical outcomes of urine cultures ordered, antibiotic use, and episodes of Clostridium
difficile infection using Corporate Data Warehouse and review of selected charts at each site. 2b: We will
study the relationship between the dose of the intervention delivered and clinical outcomes. Aim 3: Assess the
economic implications of the intervention through a budget impact analysis. Methods: Our intervention will
include an on-ramp period for each facility consisting of centrally-led ...

## Key facts

- **NIH application ID:** 9653885
- **Project number:** 5I01HX002171-02
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** BARBARA Wells TRAUTNER
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-02-01 → 2021-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9653885

## Citation

> US National Institutes of Health, RePORTER application 9653885, Less is More: Improving Antimicrobial Stewardship for Asymptomatic Bacteriuria (5I01HX002171-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9653885. Licensed CC0.

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