Major article
A survey of resident physicians' knowledge regarding urine testing and subsequent antimicrobial treatment

https://doi.org/10.1016/j.ajic.2013.01.020Get rights and content

Background

Asymptomatic bacteriuria is often treated with antimicrobials despite no benefit to patients, contributing to antimicrobial resistance and costs. Identifying knowledge deficits may improve physician training and antimicrobial stewardship efforts. We surveyed internal medicine and medicine–pediatrics resident physicians about their knowledge and attitudes regarding urine testing and subsequent management.

Methods

We surveyed 280 resident physicians at Jackson Memorial Hospital/University of Miami Miller School of Medicine and the University of Minnesota Medical School, using patient management questions based on clinical vignettes. Overall knowledge, assessed by calculating the percentage of correct answers, was assessed for correlation with demographic information, training, and experience.

Results

Of 100 responses (36% response rate), the mean percentage of correct answers was 48% (range for individual questions, 19%-85%). Experience and demographic factors demonstrated no association with overall knowledge. Training appeared to be associated with overall knowledge, with third-year residents having significantly higher percentages of correct answers compared with first-year residents (53% vs 40%; P = .03), but this was nonsignificant when adjusted for multiple comparisons (P = .18). Knowledge was significantly better for questions regarding surgical versus nonsurgical scenarios (63% vs 37%; P < .001), and for questions for which the correct answer was to start antimicrobials, versus withholding antimicrobials/limiting further testing (83% vs 39%; P < .001).

Conclusions

Knowledge deficits may contribute to unnecessary detection and treatment of asymptomatic bacteriuria.

Section snippets

Subjects

Potential subjects were resident physicians in internal medicine and medicine–pediatrics at 2 publically funded medical schools, the Jackson Memorial Hospital/University of Miami Miller School of Medicine and the University of Minnesota Medical School. To reach this population, we obtained e-mail addresses for all resident physicians enrolled in these training programs as of July 1, 2011 (University of Miami n = 137, University of Minnesota n = 143). Each resident received an e-mail notifying

Results

Invitations were sent to 280 resident physicians, including 207 internal medicine residents, 60 medicine–pediatrics residents, and 13 chief residents, resulting in 100 total responses (36% response rate). There were 42 respondents from the University of Miami and 58 from the University of Minnesota. Respondents were 51% male, with a mean ± SD age of 29 ± 3 years. Most (n = 76) were internal medicine residents (including 5 chief residents), with the remaining 24 being medicine–pediatrics

Discussion

In our survey of internal medicine and medicine–pediatrics resident physicians, which we believe is the first study to address resident physicians' knowledge regarding urine testing and subsequent management, we documented that knowledge was poor overall, with the mean percentage of correct answers being below 50%. Knowledge did not vary significantly in relation to self-reported experience managing UTIs, having had an infectious disease rotation, or any of the assessed demographic factors,

Conclusions

Our multisite survey of internal medicine and medicine–pediatric resident physicians demonstrates that trainee knowledge regarding urine testing and subsequent treatment is suboptimal, and does not vary significantly with training level, experience in UTI management, or exposure to IDSA guidelines or an infectious disease rotation. Our findings correspond with the common practice of treating ASB as a clinically significant UTI,1, 2, 3 which suggests that our results are not simply testing

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    This study was supported by the resources of the Minneapolis Veterans Affairs Health Care System, including the Center for Epidemiological and Clinical Research.

    Conflicts of interest: J.R.J. has research grants or contracts with Merck, Rochester Medical, and Syntiron.

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