Jonathan D Grein1, Katherine L Kahn2, Samantha J Eells3, Seong K Choi4, Marianne Go-Wheeler5, Tanzib Hossain5, Maya Y Riva6, Megan H Nguyen3, A Rekha Murthy1, Loren G Miller3. 1. 1Department of Hospital Epidemiology,Cedars-Sinai Medical Center,Los Angeles,California. 2. 2David Geffen School of Medicine,Division of General Internal Medicine and Health Services Research,University of California-Los Angeles (UCLA),California. 3. 3Division of Infectious Diseases,Harbor-UCLA Medical Center,and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center,Los Angeles,California. 4. 6Cedars-Sinai/UCLA Multicampus Fellowship Program in Infectious Diseases,Los Angeles,California. 5. 7Department of Medicine,Harbor-UCLA Medical Center,Torrance,California. 6. 9College of Pharmacy,Western University of Health Sciences,Pomona,California.
Abstract
BACKGROUND: Antibiotic treatment for asymptomatic bacteriuria (ASB) is prevalent but often contrary to published guidelines. OBJECTIVE: To evaluate risk factors for treatment of ASB. DESIGN: Retrospective observational study. SETTING: A tertiary academic hospital, county hospital, and community hospital. PATIENTS: Hospitalized adults with bacteriuria. METHODS: Patients without documented symptoms of urinary tract infection per Infectious Diseases Society of America (IDSA) criteria were classified as ASB. We examined ASB treatment risk factors as well as broad-spectrum antibiotic usage and quantified diagnostic concordance between IDSA and National Healthcare Safety Network criteria. RESULTS: Among 300 patients with bacteriuria, ASB was present in 71% by IDSA criteria. By National Healthcare Safety Network criteria, 71% of patients had ASB; within-patient diagnostic concordance with IDSA was moderate (kappa, 0.52). After excluding those given antibiotics for nonurinary indications, antibiotics were given to 38% (62/164) with ASB. Factors significantly associated with ASB treatment were elevated urine white cell count (65 vs 24 white blood cells per high-powered field, P<.01), hospital identity (hospital C vs A, odds ratio, 0.34 [95% CI, 0.14-0.80], P =.01), presence of leukocyte esterase (5.48 [2.35-12.79], P<.01), presence of nitrites (2.45 [1.11-5.41], P=.03), and Escherichia coli on culture (2.4 [1.2-4.7], P=.01). Of patients treated for ASB, broad-spectrum antibiotics were used in 84%. CONCLUSIONS: ASB treatment was prevalent across settings and contributed to broad-spectrum antibiotic use. Associating abnormal urinalysis results with the need for antibiotic treatment regardless of symptoms may drive unnecessary antibiotic use.
BACKGROUND: Antibiotic treatment for asymptomatic bacteriuria (ASB) is prevalent but often contrary to published guidelines. OBJECTIVE: To evaluate risk factors for treatment of ASB. DESIGN: Retrospective observational study. SETTING: A tertiary academic hospital, county hospital, and community hospital. PATIENTS: Hospitalized adults with bacteriuria. METHODS:Patients without documented symptoms of urinary tract infection per Infectious Diseases Society of America (IDSA) criteria were classified as ASB. We examined ASB treatment risk factors as well as broad-spectrum antibiotic usage and quantified diagnostic concordance between IDSA and National Healthcare Safety Network criteria. RESULTS: Among 300 patients with bacteriuria, ASB was present in 71% by IDSA criteria. By National Healthcare Safety Network criteria, 71% of patients had ASB; within-patient diagnostic concordance with IDSA was moderate (kappa, 0.52). After excluding those given antibiotics for nonurinary indications, antibiotics were given to 38% (62/164) with ASB. Factors significantly associated with ASB treatment were elevated urine white cell count (65 vs 24 white blood cells per high-powered field, P<.01), hospital identity (hospital C vs A, odds ratio, 0.34 [95% CI, 0.14-0.80], P =.01), presence of leukocyte esterase (5.48 [2.35-12.79], P<.01), presence of nitrites (2.45 [1.11-5.41], P=.03), and Escherichia coli on culture (2.4 [1.2-4.7], P=.01). Of patients treated for ASB, broad-spectrum antibiotics were used in 84%. CONCLUSIONS:ASB treatment was prevalent across settings and contributed to broad-spectrum antibiotic use. Associating abnormal urinalysis results with the need for antibiotic treatment regardless of symptoms may drive unnecessary antibiotic use.
Authors: Timothy H Dellit; Robert C Owens; John E McGowan; Dale N Gerding; Robert A Weinstein; John P Burke; W Charles Huskins; David L Paterson; Neil O Fishman; Christopher F Carpenter; P J Brennan; Marianne Billeter; Thomas M Hooton Journal: Clin Infect Dis Date: 2006-12-13 Impact factor: 9.079
Authors: Kalpana Gupta; Thomas M Hooton; Kurt G Naber; Björn Wullt; Richard Colgan; Loren G Miller; Gregory J Moran; Lindsay E Nicolle; Raul Raz; Anthony J Schaeffer; David E Soper Journal: Clin Infect Dis Date: 2011-03-01 Impact factor: 9.079
Authors: Megan K Shaughnessy; William H Amundson; Michael A Kuskowski; Douglas D DeCarolis; James R Johnson; Dimitri M Drekonja Journal: Infect Control Hosp Epidemiol Date: 2012-12-19 Impact factor: 3.254
Authors: Dimitri M Drekonja; Lilian M Abbo; Michael A Kuskowski; Christina Gnadt; Bhavarth Shukla; James R Johnson Journal: Am J Infect Control Date: 2013-03-29 Impact factor: 2.918
Authors: Scott Fridkin; James Baggs; Ryan Fagan; Shelley Magill; Lori A Pollack; Paul Malpiedi; Rachel Slayton; Karim Khader; Michael A Rubin; Makoto Jones; Matthew H Samore; Ghinwa Dumyati; Elizabeth Dodds-Ashley; James Meek; Kimberly Yousey-Hindes; John Jernigan; Nadine Shehab; Rosa Herrera; Clifford L McDonald; Amy Schneider; Arjun Srinivasan Journal: MMWR Morb Mortal Wkly Rep Date: 2014-03-07 Impact factor: 17.586
Authors: Barbara W Trautner; M Todd Greene; Sarah L Krein; Heidi L Wald; Sanjay Saint; Andrew J Rolle; Sara McNamara; Barbara S Edson; Lona Mody Journal: Infect Control Hosp Epidemiol Date: 2016-10-04 Impact factor: 3.254
Authors: Satish Munigala; Rebecca Rojek; Helen Wood; Melanie L Yarbrough; Ronald R Jackups; Carey-Ann D Burnham; David K Warren Journal: Infect Control Hosp Epidemiol Date: 2019-02-21 Impact factor: 3.254