Impact of Electronic Stewardship Interventions on Antibiotic Prescribing for Asymptomatic Bacteriuria: A Multicenter Observational Study.

BACKGROUND: Inappropriate antibiotic treatment of asymptomatic bacteriuria (ASB) remains common in hospitalized patients. This study evaluated the impact of two electronic stewardship interventions across five hospitals. METHODS: This multicenter, retrospective study included adult patients (≥ 18 years old) admitted between January 2020 and January 2026 with confirmed ASB. Patients were excluded for death within 48 hours, neutropenia, receipt of antibiotics for an active infection, or urologic procedure with mucosal involvement. Two electronic interventions were implemented one year apart: a best practice advisory (BPA) prompting appropriate urine culture ordering, followed by a microbiology nudge at the time of urine culture results to encourage reassessment of therapy. Patients were categorized into pre-BPA, BPA, and BPA plus nudge (BPAN) cohorts. The primary outcome was antibiotic treatment for more than 24 hours. RESULTS: A total of 903 patients were included (pre-BPA n=572, BPA n=112, BPAN n=219). Antibiotic treatment beyond 24 hours occurred in 53.7% of patients in the pre-BPA cohort, compared to 34.8% in the BPA cohort and 45.7% in the BPAN group (p < 0.01). CONCLUSION: Electronic stewardship interventions reduced unnecessary antibiotic treatment of ASB. Active alerts at the time of urine culture ordering were more effective than passive reminders introduced later in care. Interventions that require immediate action appeared to be more effective than passive reminders.