It’s a fairly common picture: the altered/declining/demented/elderly, with a small leukocytosis, and some positive elements on a urinalysis – but no clear symptoms of urinary tract infection. For lack of a better explanation, perhaps, treatment is begun with antibiotics. The benefit is uncertain, but, at the least it is more likely to benefit than harm?
This retrospective study, within the scope of its limitations, finds no reliable benefit to treatment, and more likely harms. This study performed chart reviews on 2,733 hospitalized patients with “asymptomatic bacteriuria”, as defined as a positive urine culture in the absence of documented Infectious Diseases Society of America criteria for UTI. Constitutional or non-specific symptoms in those unable to specifically report (e.g, dementia, AMS) were not considered as consistent with UTI unless multiple systemic signs of infection were also present.
Not only did nearly 80% of patients identified as ASB receive antibiotics, these authors were unable to shed light on any value of treatment. Treatment of ASB was more common in the scenario above, but was also widespread in patients capable of reporting symptoms yet having none documented. The dependence on retrospective chart abstraction limits the accuracy of their observations, but they have face validity.
Patient-oriented outcomes associated with either antibiotic treatment or non-treatment were 30-day mortality, 30-day readmission, 30-day post-discharge Emergency Department visit, C. diff infection, and duration of hospitalization. Most adjusted and unadjusted odds ratios for poorer outcomes were associated with treating ASB, but these differences were generally not statistically significant. Duration of hospitalization, however, was statistically associated with antibiotic treatment. This may be a spurious finding relating to contextual clinical confounders, but it may also represent an element of diagnostic inertia distracting from the true underlying etiology relating to hospitalization.
Regardless, consistent with this journal’s series feature “Less is More”, yet another instance in which common practice does not easily lend itself to confirmation of value.
“Risk Factors and Outcomes Associated With Treatment of Asymptomatic Bacteriuria in Hospitalized Patients”
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2748454