Antoine Laguë1,2,3, Valérie Boucher1,2,3,4, Pil Joo5,6,7, Krishan Yadav6,7, Charles Morasse3, Marcel Émond8,9,10,11. 1. Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec - Université Laval, 1401, 18ièmerue, Québec, QC, G1J 1Z4, Canada. 2. VITAM - Centre de Recherche en Santé Durable, Québec, QC, Canada. 3. Faculté de Médecine, Université Laval, Québec, QC, Canada. 4. Centre D'Excellence Sur Le Vieillissement de Québec, Québec, QC, Canada. 5. University of Ottawa, Ottawa, ON, Canada. 6. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. 7. Ottawa Hospital Research Institute, Ottawa, ON, Canada. 8. Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec - Université Laval, 1401, 18ièmerue, Québec, QC, G1J 1Z4, Canada. marcelemond1@me.com. 9. VITAM - Centre de Recherche en Santé Durable, Québec, QC, Canada. marcelemond1@me.com. 10. Faculté de Médecine, Université Laval, Québec, QC, Canada. marcelemond1@me.com. 11. Centre D'Excellence Sur Le Vieillissement de Québec, Québec, QC, Canada. marcelemond1@me.com.
Abstract
OBJECTIVES: Current guidelines suggest assessing non-infectious causes and careful observation before giving antibiotics to delirious patients with asymptomatic bacteriuria. Our study aims to describe the current practice of Canadian physicians regarding the investigation and treatment of asymptomatic bacteriuria in delirious older patients (aged ≥ 65 years). METHODS: Our team of medical experts designed and reviewed a cross-sectional online survey. Study participants were physicians who conduct their clinical practice in Canada and care for older patients with delirium in their current practice. Potential study participants were reached through Canadian associations: Canadian Geriatrics Society, the Canadian Association of Emergency Physicians, the Association des Médecins d'Urgence du Québec and members of Choosing Wisely Canada. RESULTS: 297 physicians were included. The main results show 79.4% of our participants request a urine dipstick or urinalysis in delirious patients and 52.4% immediately order a urine culture with the urinalysis. If bacteriuria is found in delirious but afebrile patients without urinary symptoms, 38% of physicians immediately treat with antibiotics, 33.8% wait for culture before initiating treatment, 14.4% treat if no other cause is found for delirium and only 13.7% would refrain from giving antibiotics. Results from respondents were similar for delirious patients with known cognitive impairment. Participants were almost unanimous (92.5%) in saying they need clear guidelines regarding the treatment of bacteriuria in older delirious patients. CONCLUSIONS: This survey highlights the heterogeneous clinical management of asymptomatic bacteriuria in delirious patients and the need for clear guidelines for patients.
OBJECTIVES: Current guidelines suggest assessing non-infectious causes and careful observation before giving antibiotics to delirious patients with asymptomatic bacteriuria. Our study aims to describe the current practice of Canadian physicians regarding the investigation and treatment of asymptomatic bacteriuria in delirious older patients (aged ≥ 65 years). METHODS: Our team of medical experts designed and reviewed a cross-sectional online survey. Study participants were physicians who conduct their clinical practice in Canada and care for older patients with delirium in their current practice. Potential study participants were reached through Canadian associations: Canadian Geriatrics Society, the Canadian Association of Emergency Physicians, the Association des Médecins d'Urgence du Québec and members of Choosing Wisely Canada. RESULTS: 297 physicians were included. The main results show 79.4% of our participants request a urine dipstick or urinalysis in delirious patients and 52.4% immediately order a urine culture with the urinalysis. If bacteriuria is found in delirious but afebrile patients without urinary symptoms, 38% of physicians immediately treat with antibiotics, 33.8% wait for culture before initiating treatment, 14.4% treat if no other cause is found for delirium and only 13.7% would refrain from giving antibiotics. Results from respondents were similar for delirious patients with known cognitive impairment. Participants were almost unanimous (92.5%) in saying they need clear guidelines regarding the treatment of bacteriuria in older delirious patients. CONCLUSIONS: This survey highlights the heterogeneous clinical management of asymptomatic bacteriuria in delirious patients and the need for clear guidelines for patients.
Authors: Manisha Juthani-Mehta; Margaret A Drickamer; Virginia Towle; Ying Zhang; Mary E Tinetti; Vincent J Quagliarello Journal: J Am Geriatr Soc Date: 2005-11 Impact factor: 5.562
Authors: Lindsay E Nicolle; Kalpana Gupta; Suzanne F Bradley; Richard Colgan; Gregory P DeMuri; Dimitri Drekonja; Linda O Eckert; Suzanne E Geerlings; Béla Köves; Thomas M Hooton; Manisha Juthani-Mehta; Shandra L Knight; Sanjay Saint; Anthony J Schaeffer; Barbara Trautner; Bjorn Wullt; Reed Siemieniuk Journal: Clin Infect Dis Date: 2019-05-02 Impact factor: 9.079