All non-ICU medicine and surgery patients at Sinai Health System who have a mid-stream urine culture ordered

Asymptomatic Bacteriuria

Urinary Tract Infections

microbiology lab will not process culture unless called

not processing urine cultures

Mount Sinai Hospital

Safety and Effectiveness of a Laboratory Intervention to Effectively NOT Treat Asymptomatic Bacteriuria

Safety and Effectiveness of a Laboratory Intervention to Effectively NOT Treat Asymptomatic Bacteriuria (SALIENT-A)

serious adverse events associated with not processing urine culture

Rate of serious adverse events in patients without symptoms who did and did not have urine specimens processed

Rate of serious adverse events due to antibiotic therapy in patients who received antibiotics for asymptomatic bacteriuria

Proportion of patients with symptomatic urinary tract infection (UTI) who did not respond to initial empiric antibiotics

individual patient data will not be available to other researchers. This is a quality improvement study

Allison McGeer

Medical Director, Infection Prevention and Control

Mount Sinai Hospital, Canada

Pre-treatment Urine culture will be done then all patients will receive empirical 3 gm oral phosphomycin fosfomycin will be taken by mouth on an empty stomach i.e. 2-3 hours after meals preferably in the evening before bed time after emptying the bladder.
The contents of 1 packet of Monuril will be dissolved in a glass of water or another non-alcoholic drink and drink immediately. Do not mix with hot water. Do not take fosfomycin in its dry form.
Response to treatment will be assessed by post-treatment urine culture.

Pre-treatment Urine culture and antimicrobial sensitivity testing will be done then all patients will receive oral culture specific antibiotic therapy in the form of five days regimen.
Response to treatment will be assessed by post-treatment urine culture.

Urinary Tract Infection

Single dose 3 gm oral fosfomycin will be taken by mouth on an empty stomach

phosphomycin

Culture-specific antibiotic treatment for 5 days

Culture specific antibiotic therapy

Mid-stream urine sample will be cultured and number of CFU per mL will be determined.

Pre-treatment Urine Culture

Susceptibility of urinary pathogens to various antimicrobials

Antimicrobial sensitivity testing

Post-treatment urine culture

the Use of Fosfomycin as a Single Dose Oral Treatment of Asymptomatic Bacteriuria

Empirical Use of Fosfomycin as a Single Dose Oral Treatment of Asymptomatic Bacteriuria

Decline in colony forming unit (CFU)/mL or absence of bacterial growth after treatment

Either extending the course of treatment into 5 or 7 days regimen or changing the antibiotic in case of inadequate initial response.

Need for urine culture and sensitivity in fosfomycin group in case of inadequate response on empirical treatment.

Incidence of adverse drug reactions as nausea, diarrhea, headache, vaginal itching, runny nose, back pain Side effects from other antibiotics in culture and sensitivity group

bacteriuria/nausea

Safety and Effectiveness of a Laboratory Intervention to Effectively NOT Treat Asymptomatic Bacteriuria

the Use of Fosfomycin as a Single Dose Oral Treatment of Asymptomatic Bacteriuria

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