Background: Nearly half of hospitalized patients with bacteriuria or treated for pneumonia receive unnecessary antibiotics (non-infectious/non-bacterial syndrome, e.g., asymptomatic bacteriuria), excess duration (antibiotics prescribed for longer than necessary), or avoidable fluoroquinolones (safer alternative available) at hospital discharge.1-3 However, it is unknown whether antibiotic overuse at discharge varies between hospitals or is associated with patient outcomes. [...]

Background: Inappropriate diagnosis of urinary tract infections (UTI) contributes to antibiotic overuse. We previously validated and refined a patient safety measure that defines inappropriate diagnosis of UTI (i.e., treatment of asymptomatic bacteriuria [ASB]) and was endorsed by the National Quality Forum. Use of this measure as a pay-for-performance metric in the Michigan Hospital Medicine Safety [...]

Background: Asymptomatic bacteriuria (ASB), or bacterial growth on urine culture without localizing urinary symptoms, is common in hospitalized patients.1,2 ASB is often misdiagnosed as urinary tract infection (UTI) and treated with antibiotics3 despite no improvement in mortality1 and multiple harms associated with antibiotic overuse.4,5 To reduce treatment of ASB, many hospitals set urinalysis parameters (e.g. [...]

Case Presentation: A 56-year-old male with uncontrolled Type II diabetes presented to urgent care with back pain in the absence of urinary tract symptoms. Urine cultures were positive for Methicillin-resistant Staphylococcus aureus (MRSA) and he was diagnosed with pyelonephritis and treated with Bactrim. His back pain persisted and he re-presented to the outside hospital. Finally, [...]

Background: The ABIM Foundation’s Choosing Wisely Campaign and The Infectious Diseases Society of America recommend against screening and treating for suspected urinary tract infections (UTI) unless patients are symptomatic or meet specific clinical parameters (1). Inappropriate testing for UTIs with urinalysis and urine cultures is prevalent in healthcare and may lead to waste in resources, [...]