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Management of Bacteriuria in Veterans Affairs Hospitals.
Clin Infect Dis. 2017 May 20;:
Authors: Spivak ES, Burk M, Zhang R, Jones MM, Neuhauser MM, Goetz MB, Cunningham FE, Management of Urinary Tract Infections Medication Use Evaluation Group
Abstract
Background: Bacteriuria contributes to antibiotic overuse through treatment of asymptomatic bacteriuria (ASB) and long durations of therapy for symptomatic urinary tract infections (UTIs), yet large-scale evaluations of bacteriuria management among inpatients are lacking.
Methods: Inpatients with bacteriuria were classified as asymptomatic or symptomatic based on established criteria applied to data collected by manual chart review. We examined frequency of treatment of ASB, factors associated with treatment of ASB, durations of therapy, and frequency of complications including Clostridium difficile infection, readmission and all-cause mortality within 28 days of discharge.
Results: Among 2225 episodes of bacteriuria, 64% were classified as ASB. After excluding patients with non-UTI indications for antibiotics, 72% of patients with ASB received antibiotics. When evaluating only patients not meeting SIRS criteria, 68% of patients with ASB received antibiotics. The mean (+/- SD) days of antibiotic therapy for ASB, cystitis, CA-UTI and pyelonephritis were 10.0 (4.5), 11.4 (4.7), 12.0 (6.1) and 13.6 (5.3), respectively. 14% of patients with ASB were treated for greater than 14 days, and fluoroquinolones were the most commonly used empiric antibiotic for ASB [245/691 (35%)]. Complications were rare, but more common among patients with ASB treated with antibiotics.
Conclusions: The majority of bacteriuria among inpatient Veterans is due to ASB with high rates of treatment of ASB and prolonged durations of therapy for ASB and symptomatic UTIs.
PMID: 28531289 [PubMed - as supplied by publisher]