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Treatment for Positive Urine Cultures in Hospitalized Adults: A Survey of Prevalence and Risk Factors in 3 Medical Centers

Published online by Cambridge University Press:  26 November 2015

Jonathan D. Grein ,
Katherine L. Kahn ,
Samantha J. Eells ,
Seong K. Choi ,
Marianne Go-Wheeler ,
Tanzib Hossain ,
Maya Y. Riva ,
Megan H. Nguyen ,
A. Rekha Murthy  and
Loren G. Miller
Jonathan D. Grein*
Affiliation:
Department of Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California
Katherine L. Kahn
Affiliation:
David Geffen School of Medicine, Division of General Internal Medicine and Health Services Research, University of California–Los Angeles (UCLA), California
Samantha J. Eells
Affiliation:
Division of Infectious Diseases, Harbor-UCLA Medical Center, and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California UCLA Jonathan and Karin Fielding School of Public Health, Department of Epidemiology, Los Angeles, California Science 37, Los Angeles, California
Seong K. Choi
Affiliation:
Cedars-Sinai/UCLA Multicampus Fellowship Program in Infectious Diseases, Los Angeles, California
Marianne Go-Wheeler
Affiliation:
Department of Medicine, Harbor-UCLA Medical Center, Torrance, California
Tanzib Hossain
Affiliation:
Department of Medicine, Harbor-UCLA Medical Center, Torrance, California Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
Maya Y. Riva
Affiliation:
College of Pharmacy, Western University of Health Sciences, Pomona, California
Megan H. Nguyen
Affiliation:
Division of Infectious Diseases, Harbor-UCLA Medical Center, and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California College of Pharmacy, Western University of Health Sciences, Pomona, California Department of Pharmacy, St. Mary Medical Center, Long Beach, California
A. Rekha Murthy
Affiliation:
Department of Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California
Loren G. Miller
Affiliation:
Division of Infectious Diseases, Harbor-UCLA Medical Center, and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California
*
Address correspondence to Jonathan D. Grein, MD, David Geffen School of Medicine at UCLA, Department of Hospital Epidemiology, Cedars-Sinai Medical Center, 8635 W Third St, Ste 1150-West, Los Angeles, CA 90048 ([email protected]).
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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.

Infect. Control Hosp. Epidemiol. 2016;37(3):319–326

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 3 , March 2016 , pp. 319 - 326
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: IDWeek; Philadelphia, Pennsylvania; October 9, 2014 (abstract 143).

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