Asymptomatic bacteriuria patients receive inappropriate antibiotics, finds JAMA Study

USA: Hospitalized patients with asymptomatic bacteriuria (ASB) are given inappropriate antibiotics which are associated with longer duration of hospitalization and unlikely to improve outcomes, according to a recent study.

The study, published in the JAMA Internal Medicine journal, shows the potential harm of using antibiotics to treat hospitalized patients with bacteriuria in the absence of urinary symptoms.

Antibiotics use for ASB treatment is a common factor in inappropriate use, but outcomes and risk factors associated with ASB treatment in hospitalized patients are not well defined.

Treatment of asymptomatic bacteriuria (ASB) with antibiotics is a common factor in inappropriate antibiotic use, but risk factors and outcomes associated with the treatment of ASB in hospitalized patients are not well defined.

Lindsay A. Petty, Division of Infectious Diseases, University of Michigan, Ann Arbor, and colleagues evaluated factors associated with the treatment of ASB among hospitalized patients and the possible association between treatment and clinical outcomes.

This retrospective cohort study was conducted from January 1, 2016, through February 1, 2018, at 46 hospitals participating in the Michigan Hospital Medicine Safety Consortium. It involved a total of 2733 hospitalized medical patients with ASB were included in the analysis. ASB was defined as a positive urine culture without any documented signs or symptoms attributable to urinary tract infection.

Key findings include:

• Of 2733 patients with ASB, 2138 were women (78.2%); median age was 77 years).


• A total of 2259 patients (82.7%) were treated with antibiotics for a median of 7 days (IQR, 4-9 days).


• Factors associated with ASB treatment included older age, dementia, acutely altered mental status, urinary incontinence, leukocytosis (white blood cell count >10 000/μL), positive urinalysis (presence of leukocyte esterase or nitrite, or >5 white blood cells per high-power field), and urine culture with a bacterial colony count greater than 100 000 colony-forming units per high-power field.


• Treatment of ASB was associated with longer duration of hospitalization after urine testing (4 vs 3 days; relative risk).


• No other differences in secondary outcomes were identified after propensity weighting.

"To possibly reduce inappropriate antibiotic use, stewardship efforts should focus on improving urine testing practices and management strategies for elderly patients with altered mental status," concluded the authors.

To read the complete study log on to doi:10.1001/jamainternmed.2019.2871