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No benefit, longer hospital stay with treatment of asymptomatic bacteriuria
Clinical Question
What factors and outcomes are associated with inappropriate treatment of asymptomatic bacteriuria?
Bottom line
Inappropriate treatment of asymptomatic bacteriuria (ASB) is common in hospitalized patients. Older patients, those with dementia or acutely altered mental status, and those with abnormal urinalysis results are more likely to be treated with antibiotics. Treatment did not improve clinical outcomes and was associated with a longer hospital stay. 2b
Reference
Study design: Cohort (retrospective)
Funding: Industry
Setting: Inpatient (ward only)
Synopsis
Using data from the Michigan Hospital Medicine Safety Consortium, these investigators identified 2733 hospitalized patients with ASB, defined as a positive urine culture without signs or symptoms of a urinary tract infection (UTI), such as dysuria, urinary frequency or urgency, suprapubic pain, fever, costovertebral pain or tenderness, hematuria, and autonomic dysreflexia/spasticity in spinal cord injury patients. Patients with altered mental status but no other signs or symptoms of UTI and no evidence of systemic infection were categorized as having ASB. The presence of UTI or ASB was based on chart review and thus potentially flawed (the quality of documentation may have varied). The median age of the cohort was 77 years, almost 80% were women, and 83% were treated with antibiotics for a median of 7 days. After multivariable analysis, factors associated with treatment of ASB included older age, dementia, urinary incontinence, altered mental status, urine culture with Escherichia coli, leukocytosis, bacteriuria greater than 100,000 CFU, and a positive urinalysis (defined as the presence of leukocyte esterase or nitrite, or more than 5 white blood cells per high-power field). When comparing patients with ASB who received antibiotics and those who did not, there were no differences in 30-day mortality, readmissions, emergency department visits, discharge to post-acute care facility, or Clostridioides difficile infection. Those who received antibiotic treatment had a 37% increase in hospital length of stay (4 days vs 3 days; relative risk 1.37, 95% CI 1.28 - 1.47).
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Comments
Looks like the antibiotic…
Looks like the antibiotic treated group had more preexisting comorbidities than untreated group, which might account for their 1 day longer hospital stay. Thus, 'treatment was associated with a longer hospital stay' does not necessarily imply a causal relationship with the antibiotics.