Clinical experienceBacteriuria in a Geriatric Hospital: Impact of an Antibiotic Improvement Program
Section snippets
Study Design
This prospective study was conducted from July 1, 2003, to June 30, 2004, in a geriatric university-affiliated hospital that has 32 acute care beds, 68 intermediate-care beds, and 105 extended-stay beds. Before the beginning of the study, the Infection Control and Antimicrobial Committee of the hospital developed simple recommendations for treating infections. Briefly, these recommendations included the following points, in accordance with recent guidelines: antimicrobials were not recommended
Patients and Urine Cultures
During the 12-month study period, 252 positive urine cultures in 181 patients were included. The sex ratio (F/M) was 4 (145/36) and mean age was 85.0 ± 8.6 years (median, 86; range, 63–102 years). Of the 252 cultures, 49 (19%) occurred in patients with indwelling urinary catheters. In each of 15 cultures, 2 strains were isolated, including 4 yeast strains (not studied here). The 263 bacteria were distributed as follows: Escherichia coli (n = 142, 54%), Klebsiella spp (n = 22, 8%), Pseudomonas
Discussion
UTI is the leading reason for antimicrobial treatment in institutionalized older individuals.1 Thus, well-defined criteria must be used to distinguish AB from UTI requiring antimicrobial therapy. In this study, AB was defined as bacteriuria with no signs or symptoms. It is worth noting that half the bacteriuria cases were classified as ABs, suggesting that urine cultures were frequently obtained in patients who had no symptoms or signs.
Before the intervention of the IDC, 20% of AB cases, 43% of
References (16)
Asymptomatic bacteriuria in the elderly
Infect Dis Clin North Am
(1997)Urinary infections in the elderly: Symptomatic or asymptomatic?
Int J Antimicrobial Agents
(1999)Epidemiology and unique aspects of aging and infectious diseases
Clin Infect Dis
(2000)- et al.
Antimicrobial use in long term care facilities
Infect Control Hospital Epidemiol
(2000) Antimicrobial resistance and aging: Beginning of the end of the antibiotic era?
J Am Geriatr Soc
(2002)Urinary tract infection in long-term-care facilities
Infect Control Hosp Epidemiol
(2001)- et al.
Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women
Ann Intern Med
(1994) - et al.
Infectious Diseases Society of America Guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults
Clin Infect Dis
(2005)
Cited by (27)
Survey finds improvement in cognitive biases that drive overtreatment of asymptomatic bacteriuria after a successful antimicrobial stewardship intervention
2016, American Journal of Infection ControlCitation Excerpt :Our study is in line with other studies showing that lack of knowledge of guidelines and misconceptions of what the guidelines recommend (ie, cognitive biases) are barriers for evidence-based care of ASB.12-15 Other intervention-based studies have decreased antibiotic overuse for ASB by using education, pocket cards, audit and feedback, and computer-based reminders.18-25 However, none of these studies have explored the influence of the intervention on intermediate outcomes such as change in knowledge and attitude.
Lessons from audit and feedback of hospitalized patients with bacteriuria
2014, American Journal of Infection ControlApproach to a positive urine culture in a patient without urinary symptoms
2014, Infectious Disease Clinics of North AmericaCitation Excerpt :One obvious practical consideration is that to implement this approach, testing of urine before catheter removal would need to be performed in time to have urine culture results at catheter removal or shortly thereafter. Several interventional studies have addressed the issue of inappropriate treatment of ASB (Table 2).73–79 These guidelines implementation interventions were heterogeneous and measured different outcomes.
Evidence-Based Protocol. Diagnosis and Treatment of Catheter-Associated Urinary Tract Infection Within Adult Neurocritical Care Patient Population
2014, Nursing Clinics of North AmericaCitation Excerpt :According to the 2005 Infectious Diseases Society of America (IDSA) guidelines, CA-ASB is not a clinically significant condition, and treatment is unlikely to confer clinical benefit.9 A significant limitation between evidence-based guidelines concerning management of CA-ASB and clinical practice has been documented, however, in recent publications from the United States, the United Kingdom, France, and Canada.10–14 Significant numbers of patients are being diagnosed inappropriately with CA-UTI, for which they receive treatment that is not recommended.
Treatment of Bacteriuria in Older Adults: Still Room for Improvement
2008, Journal of the American Medical Directors AssociationSafety, effectiveness and sustainability of a laboratory intervention to de-adopt culture of midstream urine samples among hospitalized patients
2021, Infection Control and Hospital Epidemiology
The authors have no conflicts of interest pertaining to this article.