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American Journal of Health-System Pharmacy, Vol. 62, Issue 1, 74-77
Copyright © 2005 by American Society of Health-System Pharmacists
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Controlling antimicrobial use and decreasing microbiological laboratory tests for urinary tract infections in spinal-cord-injury patients with chronic indwelling catheters

Palak S. Shah, Joan P. Cannon, Christine L. Sullivan, Bernard Nemchausky and Constance T. Pachucki

PALAK S. SHAH, PHARM.D., is Clinical Pharmacist, Department of Clinical Services, Caremark Inc., Northbrook, IL; at the time of writing he was Clinical Pharmacist, Department of Pharmacy, Mayo Clinic, Jacksonville, FL, and Clinical Pharmacist, St. Luke’s Hospital, Jacksonville. JOAN P. CANNON, PHARM.D., is Infectious Diseases Clinical Pharmacist, Department of Pharmacy Services; CHRISTINE L. SULLIVAN, M.S., M.B.A., is Statistician, Department of Research; BERNARD NEMCHAUSKY, M.D., is Service Chief, Department of Spinal Cord Injury; and CONSTANCE T. PACHUCKI, M.D., is Chief, Infection Control, Section of Infectious Diseases, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL.

Address correspondence to Dr. Pachucki at Edward Hines Jr. Veterans Affairs Hospital, 5th Avenue and Roosevelt Road, Hines, IL 60141 (constance.pachucki{at}med.va.gov).


Purpose. The effect of replacing the indwelling catheter of patients suspected of having a urinary tract infection (UTI) before collecting a urine sample on the number of organisms isolated in cultures and on drug and microbiology laboratory costs was studied.

Methods. Data were collected for all patients hospitalized in two spinal cord injury (SCI) units between October 2001 and March 2002 who had an indwelling catheter or suprapubic catheter and were suspected of having a UTI. Urine samples were obtained through a port of the indwelling catheter in one SCI unit, while the indwelling catheter was replaced immediately before each urine sample was obtained in the second SCI unit. Patient demographics, history of antimicrobial use, bacterial isolate sensitivity data, and current antimicrobial treatment were recorded.

Results. A total of 85 patients, 41 in the control group and 44 in the intervention group, were enrolled during the six-month study period. In the control and intervention groups, 93 and 79 organisms were isolated, respectively, with an average of 2 isolates per patient in the control group and 1 per patient in the intervention group. Patients in the control group had significantly more multidrug-resistant organisms in their urine, with 34 isolated from 26 patients (63%) (p < 0.001). Changing the indwelling catheter decreased antimicrobial and microbiology laboratory costs, resulting in a cost saving of $15.64 per patient.

Conclusion. Replacement of the indwelling catheter before collecting a urine sample for culture and conducting susceptibility testing reduced the pathogens identified, the number of toxic antimicrobials prescribed to treat the infection, and the costs of antimicrobials and microbiology laboratory technician time.

Index terms: Antiinfective agents; Catheters; Costs; Drug use; Economics; Resistance; Spinal cord injuries; Tests, laboratory; Urinary tract infections

 

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