HMS Antimicrobial Use Toolkit

Develop institutional guidelines, locally adapted from national and HMS guidelines, for treatment of community-acquired pneumonia (CAP) and urinary tract infection (UTI)/asymptomatic bacteriuria (ASB). If institution specific guidelines already exist, they should comply with the following:

CAP

Institutional guidelines should:

• Recommend 5-day antibiotic treatment duration for uncomplicated CAP
• Reflect the IDSA/ATS CAP guidelines, taking into account pneumonia severity and risk factors for MRSA and antibiotic-resistant Gram-negative pathogens, which may warrant broader empiric antibiotic therapy
• Provide recommendations for transition to oral therapy
• De-emphasize fluoroquinolones

UTI/ASB

Institutional guidelines should:

• • Recommend against sending urine cultures in the absence of urinary symptoms
  • Recommend against treating a positive urine culture in the absence of urinary symptoms
  • De-emphasize fluoroquinolones
  • Provide recommendations for transition to oral therapy

• Share the CAP and UTI/ASB guidelines with members of the work group and front-line providers to get feedback and to ensure buy-in.
• Publish guidelines in multiple formats, including booklets, hospital intranet, or an application for smartphones.
• Share HMS data and local opportunities for improvement institution-wide.

Examples of guidelines that could be locally-adapted to your institution:

• National Guidelines:
  • Infectious Diseases Society of America (IDSA)/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clinic Infect Dis 2019.
  • IDSA Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults. Clinic Infect Dis 2019.
  • IDSA Guidelines for Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection (CA-UTI) in Adults. Clinic Infect Dis 2010.
  • Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute-Care Hospitals: 2022 Update
    • Podcast discussing this update: The ICHE Podcast – Episode 40, Volume 44, Issue 8
  • IDSA Complicated Urinary Tract Infection: Clinical Guidelines for Treatment and Management. Published 7/17/25.
• HMS Guidelines:
  • CAP
  • UTI
• Institutional Guideline Examples:
  • CAP Guideline Example #1 (Michigan Medicine)
  • CAP Guideline Example #2 (Trinity Health Ann Arbor)
  • UTI Guideline Example (Michigan Medicine)
  • UTI Clinical Pathway (Corewell Health Grand Rapids)
  • Regional Antibiogram and Antimicrobial Guideline Example (McLaren Northern Michigan and Munson Medical Center)
• Pocket Card Examples:
  • CAP
  • UTI

• Frisbee J, et al. Adverse Outcomes Associated with Potentially Inappropriate Antibiotic Use in Heart Failure Admissions. Open Forum Inf Dis 2019.
  • ADHF patients who received IV antibiotics without evidence of infection had longer lengths of stay, required more diuretics, and were more likely to be readmitted compared with ADHF patients not exposed to IV antibiotics. ADHF patients are a promising target of antibiotic stewardship interventions.
• Gupta A, et al. Overdiagnosis of Urinary Tract Infection Linked to Overdiagnosis of Pneumonia: A Multihospital Cohort Study. BMJ Qual & Safety 2022.
  • Discusses the correlation between overdiagnosis of UTI and CAP leading to unnecessary antibiotic user and diagnostic delay.
  • Assessed diagnostic momentum, where overdiagnosed patients started on antibiotics by an Emergency Medicine clinical remained on antibiotics on day 3 of hospitalization