Treatment for Positive Urine Cultures in Hospitalized Adults: A Survey of Prevalence and Risk Factors in 3 Medical Centers
Antibiotic treatment for asymptomatic bacteriuria (ASB) is prevalent but often contrary to published guidelines. To evaluate risk factors for treatment of ASB. Retrospective observational study. A tertiary academic hospital, county hospital, and community hospital. Hospitalized adults with bacteriur...
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| Veröffentlicht in: | Infection control and hospital epidemiology 2016-03, Vol.37 (3), p.319-326 |
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| creator | Grein, Jonathan D. Kahn, Katherine L. Eells, Samantha J. Choi, Seong K. Go-Wheeler, Marianne Hossain, Tanzib Riva, Maya Y. Nguyen, Megan H. Rekha Murthy, A. Miller, Loren G. |
| description | Antibiotic treatment for asymptomatic bacteriuria (ASB) is prevalent but often contrary to published guidelines.
To evaluate risk factors for treatment of ASB.
Retrospective observational study.
A tertiary academic hospital, county hospital, and community hospital.
Hospitalized adults with bacteriuria.
Patients without documented symptoms of urinary tract infection per Infectious Diseases Society of America (IDSA) criteria were classified as ASB. We examined ASB treatment risk factors as well as broad-spectrum antibiotic usage and quantified diagnostic concordance between IDSA and National Healthcare Safety Network criteria.
Among 300 patients with bacteriuria, ASB was present in 71% by IDSA criteria. By National Healthcare Safety Network criteria, 71% of patients had ASB; within-patient diagnostic concordance with IDSA was moderate (kappa, 0.52). After excluding those given antibiotics for nonurinary indications, antibiotics were given to 38% (62/164) with ASB. Factors significantly associated with ASB treatment were elevated urine white cell count (65 vs 24 white blood cells per high-powered field, P |
| doi_str_mv | 10.1017/ice.2015.281 |
| format | Article |
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To evaluate risk factors for treatment of ASB.
Retrospective observational study.
A tertiary academic hospital, county hospital, and community hospital.
Hospitalized adults with bacteriuria.
Patients without documented symptoms of urinary tract infection per Infectious Diseases Society of America (IDSA) criteria were classified as ASB. We examined ASB treatment risk factors as well as broad-spectrum antibiotic usage and quantified diagnostic concordance between IDSA and National Healthcare Safety Network criteria.
Among 300 patients with bacteriuria, ASB was present in 71% by IDSA criteria. By National Healthcare Safety Network criteria, 71% of patients had ASB; within-patient diagnostic concordance with IDSA was moderate (kappa, 0.52). After excluding those given antibiotics for nonurinary indications, antibiotics were given to 38% (62/164) with ASB. Factors significantly associated with ASB treatment were elevated urine white cell count (65 vs 24 white blood cells per high-powered field, P<.01), hospital identity (hospital C vs A, odds ratio, 0.34 [95% CI, 0.14-0.80], P =.01), presence of leukocyte esterase (5.48 [2.35-12.79], P<.01), presence of nitrites (2.45 [1.11-5.41], P=.03), and Escherichia coli on culture (2.4 [1.2-4.7], P=.01). Of patients treated for ASB, broad-spectrum antibiotics were used in 84%.
ASB treatment was prevalent across settings and contributed to broad-spectrum antibiotic use. Associating abnormal urinalysis results with the need for antibiotic treatment regardless of symptoms may drive unnecessary antibiotic use.</description><identifier>ISSN: 0899-823X</identifier><identifier>EISSN: 1559-6834</identifier><identifier>DOI: 10.1017/ice.2015.281</identifier><identifier>PMID: 26607408</identifier><language>eng</language><publisher>New York, USA: Cambridge University Press</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Bacteriuria - diagnosis ; Bacteriuria - epidemiology ; Catheters ; Drug resistance ; E coli ; Escherichia coli - isolation & purification ; Female ; Fever ; Health care ; Hospitalization ; Hospitals ; Humans ; Infectious diseases ; Male ; Medical records ; Microorganisms ; Middle Aged ; Nitrites ; Nursing ; Observational studies ; Odds Ratio ; Original Articles ; Patient safety ; Public health ; Retrospective Studies ; Risk Factors ; Staphylococcus infections ; Surveys and Questionnaires ; Tertiary Care Centers ; United States ; Urinalysis ; Urinary tract infections ; Urinary Tract Infections - drug therapy ; Urinary Tract Infections - epidemiology ; Urine ; Urogenital system ; Young Adult</subject><ispartof>Infection control and hospital epidemiology, 2016-03, Vol.37 (3), p.319-326</ispartof><rights>2015 by The Society for Healthcare Epidemiology of America. All rights reserved</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-dca546c1d738d8c1a081de6dad950f156da5865e5ada46c8a86bf24c4076f9983</citedby><cites>FETCH-LOGICAL-c396t-dca546c1d738d8c1a081de6dad950f156da5865e5ada46c8a86bf24c4076f9983</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2799890790/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2799890790?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>164,314,776,780,21367,27901,27902,33721,33722,43781,55603,74045</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26607408$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Grein, Jonathan D.</creatorcontrib><creatorcontrib>Kahn, Katherine L.</creatorcontrib><creatorcontrib>Eells, Samantha J.</creatorcontrib><creatorcontrib>Choi, Seong K.</creatorcontrib><creatorcontrib>Go-Wheeler, Marianne</creatorcontrib><creatorcontrib>Hossain, Tanzib</creatorcontrib><creatorcontrib>Riva, Maya Y.</creatorcontrib><creatorcontrib>Nguyen, Megan H.</creatorcontrib><creatorcontrib>Rekha Murthy, A.</creatorcontrib><creatorcontrib>Miller, Loren G.</creatorcontrib><title>Treatment for Positive Urine Cultures in Hospitalized Adults: A Survey of Prevalence and Risk Factors in 3 Medical Centers</title><title>Infection control and hospital epidemiology</title><addtitle>Infect. Control Hosp. Epidemiol</addtitle><description>Antibiotic treatment for asymptomatic bacteriuria (ASB) is prevalent but often contrary to published guidelines.
To evaluate risk factors for treatment of ASB.
Retrospective observational study.
A tertiary academic hospital, county hospital, and community hospital.
Hospitalized adults with bacteriuria.
Patients without documented symptoms of urinary tract infection per Infectious Diseases Society of America (IDSA) criteria were classified as ASB. We examined ASB treatment risk factors as well as broad-spectrum antibiotic usage and quantified diagnostic concordance between IDSA and National Healthcare Safety Network criteria.
Among 300 patients with bacteriuria, ASB was present in 71% by IDSA criteria. By National Healthcare Safety Network criteria, 71% of patients had ASB; within-patient diagnostic concordance with IDSA was moderate (kappa, 0.52). After excluding those given antibiotics for nonurinary indications, antibiotics were given to 38% (62/164) with ASB. Factors significantly associated with ASB treatment were elevated urine white cell count (65 vs 24 white blood cells per high-powered field, P<.01), hospital identity (hospital C vs A, odds ratio, 0.34 [95% CI, 0.14-0.80], P =.01), presence of leukocyte esterase (5.48 [2.35-12.79], P<.01), presence of nitrites (2.45 [1.11-5.41], P=.03), and Escherichia coli on culture (2.4 [1.2-4.7], P=.01). Of patients treated for ASB, broad-spectrum antibiotics were used in 84%.
ASB treatment was prevalent across settings and contributed to broad-spectrum antibiotic use. Associating abnormal urinalysis results with the need for antibiotic treatment regardless of symptoms may drive unnecessary antibiotic use.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Bacteriuria - diagnosis</subject><subject>Bacteriuria - epidemiology</subject><subject>Catheters</subject><subject>Drug resistance</subject><subject>E coli</subject><subject>Escherichia coli - isolation & purification</subject><subject>Female</subject><subject>Fever</subject><subject>Health care</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical records</subject><subject>Microorganisms</subject><subject>Middle Aged</subject><subject>Nitrites</subject><subject>Nursing</subject><subject>Observational studies</subject><subject>Odds Ratio</subject><subject>Original Articles</subject><subject>Patient safety</subject><subject>Public health</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Staphylococcus infections</subject><subject>Surveys and Questionnaires</subject><subject>Tertiary Care Centers</subject><subject>United States</subject><subject>Urinalysis</subject><subject>Urinary tract infections</subject><subject>Urinary Tract Infections - drug therapy</subject><subject>Urinary Tract Infections - epidemiology</subject><subject>Urine</subject><subject>Urogenital system</subject><subject>Young Adult</subject><issn>0899-823X</issn><issn>1559-6834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNptkctL7DAUh4MoOj52ri8BNy7smLRNmtzdMPgCRfEB7kImOZV422ZM2gH9683o6AVxlQP5zu8czofQPiVjSmh17AyMc0LZOBd0DY0oYzLjoijX0YgIKTORF49baDvGZ0JIJSXdRFs556QqiRiht_sAum-h63HtA77x0fVuAfghuA7wdGj6IUDErsPnPs5drxv3BhZPbPqJf_EE3w1hAa_Y1_gmwEI30BnAurP41sV_-FSb3oeP_gJfgXVGN3iapkGIu2ij1k2EvdW7gx5OT-6n59nl9dnFdHKZmULyPrNGs5IbaqtCWGGoJoJa4FZbyUhNWaqY4AyYtjpxQgs-q_PSlKTitZSi2EGHn7nz4F8GiL1qXTTQNLoDP0RFK14RLrggCT34gT77IXRpO5Wn0wmZDrikjj4pE3yMAWo1D67V4VVRopZOVHKilk5UcpLwP6vQYdaC_Ya_JCRgvMrT7Sw4-wT_x_6a-A6i-JaK</recordid><startdate>20160301</startdate><enddate>20160301</enddate><creator>Grein, Jonathan D.</creator><creator>Kahn, Katherine L.</creator><creator>Eells, Samantha J.</creator><creator>Choi, Seong K.</creator><creator>Go-Wheeler, Marianne</creator><creator>Hossain, Tanzib</creator><creator>Riva, Maya Y.</creator><creator>Nguyen, Megan H.</creator><creator>Rekha Murthy, A.</creator><creator>Miller, Loren G.</creator><general>Cambridge University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20160301</creationdate><title>Treatment for Positive Urine Cultures in Hospitalized Adults: A Survey of Prevalence and Risk Factors in 3 Medical Centers</title><author>Grein, Jonathan D. ; Kahn, Katherine L. ; Eells, Samantha J. ; Choi, Seong K. ; Go-Wheeler, Marianne ; Hossain, Tanzib ; Riva, Maya Y. ; Nguyen, Megan H. ; Rekha Murthy, A. ; Miller, Loren G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-dca546c1d738d8c1a081de6dad950f156da5865e5ada46c8a86bf24c4076f9983</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Bacteriuria - diagnosis</topic><topic>Bacteriuria - epidemiology</topic><topic>Catheters</topic><topic>Drug resistance</topic><topic>E coli</topic><topic>Escherichia coli - isolation & purification</topic><topic>Female</topic><topic>Fever</topic><topic>Health care</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Male</topic><topic>Medical records</topic><topic>Microorganisms</topic><topic>Middle Aged</topic><topic>Nitrites</topic><topic>Nursing</topic><topic>Observational studies</topic><topic>Odds Ratio</topic><topic>Original Articles</topic><topic>Patient safety</topic><topic>Public health</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Staphylococcus infections</topic><topic>Surveys and Questionnaires</topic><topic>Tertiary Care Centers</topic><topic>United States</topic><topic>Urinalysis</topic><topic>Urinary tract infections</topic><topic>Urinary Tract Infections - 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Academic</collection><jtitle>Infection control and hospital epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Grein, Jonathan D.</au><au>Kahn, Katherine L.</au><au>Eells, Samantha J.</au><au>Choi, Seong K.</au><au>Go-Wheeler, Marianne</au><au>Hossain, Tanzib</au><au>Riva, Maya Y.</au><au>Nguyen, Megan H.</au><au>Rekha Murthy, A.</au><au>Miller, Loren G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment for Positive Urine Cultures in Hospitalized Adults: A Survey of Prevalence and Risk Factors in 3 Medical Centers</atitle><jtitle>Infection control and hospital epidemiology</jtitle><addtitle>Infect. Control Hosp. Epidemiol</addtitle><date>2016-03-01</date><risdate>2016</risdate><volume>37</volume><issue>3</issue><spage>319</spage><epage>326</epage><pages>319-326</pages><issn>0899-823X</issn><eissn>1559-6834</eissn><abstract>Antibiotic treatment for asymptomatic bacteriuria (ASB) is prevalent but often contrary to published guidelines.
To evaluate risk factors for treatment of ASB.
Retrospective observational study.
A tertiary academic hospital, county hospital, and community hospital.
Hospitalized adults with bacteriuria.
Patients without documented symptoms of urinary tract infection per Infectious Diseases Society of America (IDSA) criteria were classified as ASB. We examined ASB treatment risk factors as well as broad-spectrum antibiotic usage and quantified diagnostic concordance between IDSA and National Healthcare Safety Network criteria.
Among 300 patients with bacteriuria, ASB was present in 71% by IDSA criteria. By National Healthcare Safety Network criteria, 71% of patients had ASB; within-patient diagnostic concordance with IDSA was moderate (kappa, 0.52). After excluding those given antibiotics for nonurinary indications, antibiotics were given to 38% (62/164) with ASB. Factors significantly associated with ASB treatment were elevated urine white cell count (65 vs 24 white blood cells per high-powered field, P<.01), hospital identity (hospital C vs A, odds ratio, 0.34 [95% CI, 0.14-0.80], P =.01), presence of leukocyte esterase (5.48 [2.35-12.79], P<.01), presence of nitrites (2.45 [1.11-5.41], P=.03), and Escherichia coli on culture (2.4 [1.2-4.7], P=.01). Of patients treated for ASB, broad-spectrum antibiotics were used in 84%.
ASB treatment was prevalent across settings and contributed to broad-spectrum antibiotic use. Associating abnormal urinalysis results with the need for antibiotic treatment regardless of symptoms may drive unnecessary antibiotic use.</abstract><cop>New York, USA</cop><pub>Cambridge University Press</pub><pmid>26607408</pmid><doi>10.1017/ice.2015.281</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use Antibiotics Bacteriuria - diagnosis Bacteriuria - epidemiology Catheters Drug resistance E coli Escherichia coli - isolation & purification Female Fever Health care Hospitalization Hospitals Humans Infectious diseases Male Medical records Microorganisms Middle Aged Nitrites Nursing Observational studies Odds Ratio Original Articles Patient safety Public health Retrospective Studies Risk Factors Staphylococcus infections Surveys and Questionnaires Tertiary Care Centers United States Urinalysis Urinary tract infections Urinary Tract Infections - drug therapy Urinary Tract Infections - epidemiology Urine Urogenital system Young Adult |
| title | Treatment for Positive Urine Cultures in Hospitalized Adults: A Survey of Prevalence and Risk Factors in 3 Medical Centers |
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