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Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital.

Abstract

BACKGROUND

Evidence-based guidelines state that asymptomatic bacteriuria is not a clinically significant condition in men and nonpregnant women and that treatment is unlikely to confer clinical benefit. We hypothesized that, among patients with indwelling catheters or condom collection systems, many who receive a diagnosis of and are treated for catheter-associated urinary tract infection (CAUTI) actually have asymptomatic bacteriuria and, therefore, that antibiotic therapy is inappropriate.

METHODS

We reviewed all urine culture results at a veterans affairs medical center during a 3-month period. Cultures yielding 10(4) colony-forming units/mL were included if the urine had been collected from a hospitalized patient with an indwelling (Foley) catheter or a condom collection system. We applied standardized definitions to determine whether the episode represented catheter-associated asymptomatic bacteriuria (CAABU) or CAUTI. Antibiotic therapy was considered appropriate for patients who met criteria for symptomatic UTI.

RESULTS

Overall, 280 episodes met criteria for inclusion: 164 CAABU and 116 CAUTI. Of the 164 episodes of CAABU, 111 (68%) were managed appropriately (no treatment), whereas 53 (32%) were treated with antibiotics (inappropriate treatment). In multivariate analysis, older patient age, having predominantly gram-negative bacteriuria, and higher urine white blood cell count were significantly associated with inappropriate treatment of CAABU (P < .05, by logistic regression).

CONCLUSIONS

Better recognition of CAABU and the distinction between this condition and CAUTI, consistent with evidence-based guidelines, may play a key role in reducing unneeded antibiotic usage in hospitalized patients.

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  • Authors+Show Affiliations

    ,

    Department of Internal Medicine, Duke University, Durham, North Carolina, USA.

    , , , ,

    Source

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Anti-Bacterial Agents
    Bacteriuria
    Catheter-Related Infections
    Colony Count, Microbial
    Diagnosis, Differential
    Diagnostic Errors
    Female
    Hospitals
    Humans
    Male
    Middle Aged
    Urinary Catheterization
    Young Adult

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, Non-P.H.S.

    Language

    eng

    PubMed ID

    19292664

    Citation

    Cope, Matthew, et al. "Inappropriate Treatment of Catheter-associated Asymptomatic Bacteriuria in a Tertiary Care Hospital." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 48, no. 9, 2009, pp. 1182-8.
    Cope M, Cevallos ME, Cadle RM, et al. Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital. Clin Infect Dis. 2009;48(9):1182-8.
    Cope, M., Cevallos, M. E., Cadle, R. M., Darouiche, R. O., Musher, D. M., & Trautner, B. W. (2009). Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 48(9), pp. 1182-8. doi:10.1086/597403.
    Cope M, et al. Inappropriate Treatment of Catheter-associated Asymptomatic Bacteriuria in a Tertiary Care Hospital. Clin Infect Dis. 2009 May 1;48(9):1182-8. PubMed PMID: 19292664.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital. AU - Cope,Matthew, AU - Cevallos,Manuel E, AU - Cadle,Richard M, AU - Darouiche,Rabih O, AU - Musher,Daniel M, AU - Trautner,Barbara W, PY - 2009/3/19/entrez PY - 2009/3/19/pubmed PY - 2009/5/13/medline SP - 1182 EP - 8 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 48 IS - 9 N2 - BACKGROUND: Evidence-based guidelines state that asymptomatic bacteriuria is not a clinically significant condition in men and nonpregnant women and that treatment is unlikely to confer clinical benefit. We hypothesized that, among patients with indwelling catheters or condom collection systems, many who receive a diagnosis of and are treated for catheter-associated urinary tract infection (CAUTI) actually have asymptomatic bacteriuria and, therefore, that antibiotic therapy is inappropriate. METHODS: We reviewed all urine culture results at a veterans affairs medical center during a 3-month period. Cultures yielding 10(4) colony-forming units/mL were included if the urine had been collected from a hospitalized patient with an indwelling (Foley) catheter or a condom collection system. We applied standardized definitions to determine whether the episode represented catheter-associated asymptomatic bacteriuria (CAABU) or CAUTI. Antibiotic therapy was considered appropriate for patients who met criteria for symptomatic UTI. RESULTS: Overall, 280 episodes met criteria for inclusion: 164 CAABU and 116 CAUTI. Of the 164 episodes of CAABU, 111 (68%) were managed appropriately (no treatment), whereas 53 (32%) were treated with antibiotics (inappropriate treatment). In multivariate analysis, older patient age, having predominantly gram-negative bacteriuria, and higher urine white blood cell count were significantly associated with inappropriate treatment of CAABU (P < .05, by logistic regression). CONCLUSIONS: Better recognition of CAABU and the distinction between this condition and CAUTI, consistent with evidence-based guidelines, may play a key role in reducing unneeded antibiotic usage in hospitalized patients. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/19292664/Inappropriate_treatment_of_catheter_associated_asymptomatic_bacteriuria_in_a_tertiary_care_hospital_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/597403 DB - PRIME DP - Unbound Medicine ER -