Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-25T01:57:39.576Z Has data issue: false hasContentIssue false
  • English
  • Français

Antimicrobial use for asymptomatic bacteriuria—First, do no harm

Published online by Cambridge University Press:  13 August 2020

Yana Shpunt Open the ORCID record for Yana Shpunt [Opens in a new window] ,
Inna Estrin ,
Yossef Levi ,
Hodaya Saadon ,
Galit Ben-Yossef ,
Lili Goldshtein ,
Dan Klafter ,
Shani Zilberman-Itskovich ,
Debby Ben-David  and
David E. Katz
...Show all authors
Yana Shpunt
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Inna Estrin
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Yossef Levi
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Hodaya Saadon
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Galit Ben-Yossef
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Lili Goldshtein
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Dan Klafter
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Shani Zilberman-Itskovich
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Debby Ben-David
Affiliation:
Unit of Infection Control, Wolfson Medical Center, Holon, Israel
David E. Katz
Affiliation:
Division of Internal Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
Tsillia Lazarovitch
Affiliation:
Clinical Microbiology Laboratory, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Ronit Zaidenstein
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Dror Marchaim*
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
*
Author for correspondence: Dror Marchaim, E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Administration of antimicrobials to patients with asymptomatic bacteriuria (ASB) is a common error that can lead to worse outcomes. However, controlled analyses quantifying the commonality and impact of this practice are lacking. We analyzed the independent predictors for antimicrobials misuse in ASB and quantified the impact of this practice on clinical outcomes.

Design:

Retrospective case-control and cohort analyses for calendar year 2017.

Setting:

Tertiary-care, university-affiliated medical center.

Patients:

The study included adult (>18 years) patients with positive urine culture. Pregnant women, renal transplant recipients, and patients who underwent urologic procedures were excluded.

Methods:

ASB was determined according to US Centers for Disease Control and Prevention (CDC) criteria. Multivariable logistic regression models were constructed to analyze predictors and outcomes associated with antimicrobial use for patients with ASB.

Results:

The study included 1,530 patient-unique positive urine cultures. Among these patients, 610 patients (40%) were determined to have ASB. Of the 696 isolates, 219 (36%) were multidrug-resistant organisms (MDROs). Also, 178 (29%) patients received antimicrobials specifically due to the ASB. Independent predictors for improper administration of antimicrobials were dependent functional status (adjusted odds ratio [aOR], 2.3; 95% CI, 1.4–3.6) and male sex (aOR, 2; 95% CI, 1.25–2.6). Use of antimicrobials was independently associated with re-hospitalizations (aOR, 1.7; 95% CI, 1.1–2.6) and later, acute Clostridioides difficile infections (CDI) in the following 90 days (aOR, 4.5; 95% CI, 2–10.6).

Conclusions:

ASB is a common condition, frequently resulting from an MDRO. Male sex and poor functional status were independent predictors for mistreatment, and this practice was independently associated with rehospitalizations and CDI in the following 90 days.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 1 , January 2021 , pp. 37 - 42
Check for updates
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Chu, CM, Lowder, JL. Diagnosis and treatment of urinary tract infections across age groups. Am J Obstet Gynecol 2018;219:40–51.CrossRefGoogle ScholarPubMed
Rubin, RH, Shapiro, ED, Andriole, VT, Davis, RJ, Stamm, WE. Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration. Clin Infect Dis 1992;15 suppl 1:S216–S227.CrossRefGoogle Scholar
Fridkin, S, Baggs, J, Fagan, R, et al. Vital signs: improving antibiotic use among hospitalized patients. Morb Mortal Wkly Rep 2014;63:194–200.Google ScholarPubMed
Zalmanovici Trestioreanu, A, Lador, A, Sauerbrun-Cutler, MT, Leibovici, L. Antibiotics for asymptomatic bacteriuria. Cochrane Database Syst Rev 2015;4:CD009534.Google ScholarPubMed
Steward, DK, Wood, GL, Cohen, RL, Smith, JW, Mackowiak, PA. Failure of the urinalysis and quantitative urine culture in diagnosing symptomatic urinary tract infections in patients with long-term urinary catheters. Am J Infect Control 1985;13:154–160.CrossRefGoogle ScholarPubMed
Bengtsson, C, Bengtsson, U, Bjorkelund, C, Lincoln, K, Sigurdsson, JA. Bacteriuria in a population sample of women: 24-year follow-up study. Results from the prospective population-based study of women in Gothenburg, Sweden. Scand J Urol Nephrol 1998;32:284–289.Google Scholar
Nicolle, LE. Asymptomatic bacteriuria in the elderly. Infect Dis Clin North Am 1997;11:647–662.CrossRefGoogle ScholarPubMed
Nicolle, LE, Bradley, S, Colgan, R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643–654.CrossRefGoogle Scholar
Alangaden, G. Urinary tract infections in renal transplant recipients. Curr Infect Dis Rep 2007;9:475–479.CrossRefGoogle ScholarPubMed
Youngster, I, Lazarovitch, T, Bondorenco, M, et al. The epidemiology of Clostridium difficile infections and aspects pertaining to treatment with vancomycin at Assaf Harofeh Medical Center. Harefuah 2018;157:305–308.Google ScholarPubMed
O’Donnell, AJ, Walsh, TL, Tang, A, Weinberg, L. The impact of the Hospital Elder Life Program on the treatment of asymptomatic bacteriuria: an unexpected benefit. Geriatr Nurs 2019;40:473–477.CrossRefGoogle ScholarPubMed
Saint, S, Greene, MT, Krein, SL, et al. A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med 2016;374:2111–2119.CrossRefGoogle ScholarPubMed
Force, USPST, Owens, DK, Davidson, KW, et al. Screening for asymptomatic bacteriuria in adults: US preventive services task force recommendation statement. JAMA 2019;322:1188–1194.Google Scholar
MOH Medical Administration Circular 39/2014.Google Scholar
Johnstone, J, Patel SNon behalf of the Provincial Infectious Diseases Advisory Committee – Infection Prevention and Control (PIDAC-IPC). An emerging multidrug-resistant bacteria. CMAJ 2017;189:E1115.CrossRefGoogle Scholar
National Healthcare Safety Network Patient Safety Component Manual. Atlanta: CDC; January 2018.Google Scholar
Marchaim, D, Levit, D, Zigron, R, et al. Clinical and molecular epidemiology of Acinetobacter baumannii bloodstream infections in an endemic setting. Future Microbiol 2017;12:271–283.CrossRefGoogle Scholar
Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
Petty, LA, Vaughn, VM, Flanders, SA, et al. Risk factors and outcomes associated with treatment of asymptomatic bacteriuria in hospitalized patients. JAMA Intern Med 2019.CrossRefGoogle ScholarPubMed
Adler, A, Friedman, ND, Marchaim, D. Multidrug-resistant gram-negative bacilli: infection control implications. Infect Dis Clin North Am 2016;30:967–997.CrossRefGoogle ScholarPubMed