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Antimicrobial use for asymptomatic bacteriuria—First, do no harm

Published online by Cambridge University Press:  13 August 2020

Yana Shpunt
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Inna Estrin
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Yossef Levi
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Hodaya Saadon
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Galit Ben-Yossef
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Lili Goldshtein
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Dan Klafter
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Shani Zilberman-Itskovich
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Debby Ben-David
Affiliation:
Unit of Infection Control, Wolfson Medical Center, Holon, Israel
David E. Katz
Affiliation:
Division of Internal Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
Tsillia Lazarovitch
Affiliation:
Clinical Microbiology Laboratory, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
Ronit Zaidenstein
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Dror Marchaim*
Affiliation:
Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
*Corresponding
Author for correspondence: Dror Marchaim, E-mail: drormarchaim@gmail.com.

Abstract

Objective:

Administration of antimicrobials to patients with asymptomatic bacteriuria (ASB) is a common error that can lead to worse outcomes. However, controlled analyses quantifying the commonality and impact of this practice are lacking. We analyzed the independent predictors for antimicrobials misuse in ASB and quantified the impact of this practice on clinical outcomes.

Design:

Retrospective case-control and cohort analyses for calendar year 2017.

Setting:

Tertiary-care, university-affiliated medical center.

Patients:

The study included adult (>18 years) patients with positive urine culture. Pregnant women, renal transplant recipients, and patients who underwent urologic procedures were excluded.

Methods:

ASB was determined according to US Centers for Disease Control and Prevention (CDC) criteria. Multivariable logistic regression models were constructed to analyze predictors and outcomes associated with antimicrobial use for patients with ASB.

Results:

The study included 1,530 patient-unique positive urine cultures. Among these patients, 610 patients (40%) were determined to have ASB. Of the 696 isolates, 219 (36%) were multidrug-resistant organisms (MDROs). Also, 178 (29%) patients received antimicrobials specifically due to the ASB. Independent predictors for improper administration of antimicrobials were dependent functional status (adjusted odds ratio [aOR], 2.3; 95% CI, 1.4–3.6) and male sex (aOR, 2; 95% CI, 1.25–2.6). Use of antimicrobials was independently associated with re-hospitalizations (aOR, 1.7; 95% CI, 1.1–2.6) and later, acute Clostridioides difficile infections (CDI) in the following 90 days (aOR, 4.5; 95% CI, 2–10.6).

Conclusions:

ASB is a common condition, frequently resulting from an MDRO. Male sex and poor functional status were independent predictors for mistreatment, and this practice was independently associated with rehospitalizations and CDI in the following 90 days.

Type
Original Article
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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