Management of positive urine cultures in hospitalized adults without symptoms of urinary tract infection
Methods: This is a retrospective descriptive cohort study to evaluate the current practice for the management of ABU in hospitalized adults at Baystate Medical Center from July 1, 2012 to June 30, 2013. ABU was defined as a positive urine culture (> 10,000 CFU of a single organism) without signs or symptoms of a urinary tract infection (UTI). Exclusion criteria were pregnancy, surgery during admission, history of renal transplant, other acute infectious diagnosis, symptoms of UTI, Alzheimer ’s disease, and dementia. Patients were randomized and reviewed for inclusion and exclusion criteria until the target number of 100 ABU cases was reached. Data were analyzed using descriptive statistics with 95% confidence intervals.
Results: Antibiotics were prescribed in 57% of ABU cases (95% CI 46.9 to 66.4). Greater extent of pyuria (95% CI -73.7 to -15.8), urine CFU count >100,000 (95% CI 18.3 to 66.3), and gram negative isolate (95% CI 6.3 to 49.7) are associated with antibiotic prescribing. Hospitalists and residents cared for 48% and 37% of all patients respectively, and prescribed 42% and 38% of antibiotics. One case of Clostridium difficile infection was observed in the non-antibiotic group and 2 in the antibiotic group (95% CI -5.4 to 7.7).
Conclusion: ABU is frequently treated with antibiotics despite published guidelines. Misinterpretation of urinalysis, specifically extent of pyuria, may be influencing providers to prescribe antibiotics for ABU. Urine culture results may also be influencing antibiotic prescribing, specifically high CFU counts and gram negative isolates. This information can be used to create an educational intervention targeted towards hospitalists and residents to decrease the prescribing of antibiotics in ABU.
J. Stiles, None