Assessment of Testing and Treatment of Asymptomatic Bacteriuria Initiated in the Emergency Department.
bacteriuria
emergency medicine
stewardship
urinary tract infection
Journal
Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
18
09
2020
accepted:
29
10
2020
entrez:
16
12
2020
pubmed:
17
12
2020
medline:
17
12
2020
Statut:
epublish
Résumé
Reducing antibiotic use in patients with asymptomatic bacteriuria (ASB) has been inpatient focused. However, testing and treatment is often started in the emergency department (ED). Thus, for hospitalized patients with ASB, we sought to identify patterns of testing and treatment initiated by emergency medicine (EM) clinicians and the association of treatment with outcomes. We conducted a 43-hospital, cohort study of adults admitted through the ED with ASB (February 2018-February 2020). Using generalized estimating equation models, we assessed for (1) factors associated with antibiotic treatment by EM clinicians and, after inverse probability of treatment weighting, (2) the effect of treatment on outcomes. Of 2461 patients with ASB, 74.4% (N = 1830) received antibiotics. The EM clinicians ordered urine cultures in 80.0% (N = 1970) of patients and initiated treatment in 68.5% (1253 of 1830). Predictors of EM clinician treatment of ASB versus no treatment included dementia, spinal cord injury, incontinence, urinary catheter, altered mental status, leukocytosis, and abnormal urinalysis. Once initiated by EM clinicians, 79% (993 of 1253) of patients remained on antibiotics for at least 3 days. Antibiotic treatment was associated with a longer length of hospitalization (mean 5.1 vs 4.2 days; relative risk = 1.16; 95% confidence interval, 1.08-1.23) and Among hospitalized patients ultimately diagnosed with ASB, EM clinicians commonly initiated testing and treatment; most antibiotics were continued by inpatient clinicians. Antibiotic treatment was not associated with improved outcomes, whereas it was associated with prolonged hospitalization and CDI. For best impact, stewardship interventions must expand to the ED.
Sections du résumé
BACKGROUND
BACKGROUND
Reducing antibiotic use in patients with asymptomatic bacteriuria (ASB) has been inpatient focused. However, testing and treatment is often started in the emergency department (ED). Thus, for hospitalized patients with ASB, we sought to identify patterns of testing and treatment initiated by emergency medicine (EM) clinicians and the association of treatment with outcomes.
METHODS
METHODS
We conducted a 43-hospital, cohort study of adults admitted through the ED with ASB (February 2018-February 2020). Using generalized estimating equation models, we assessed for (1) factors associated with antibiotic treatment by EM clinicians and, after inverse probability of treatment weighting, (2) the effect of treatment on outcomes.
RESULTS
RESULTS
Of 2461 patients with ASB, 74.4% (N = 1830) received antibiotics. The EM clinicians ordered urine cultures in 80.0% (N = 1970) of patients and initiated treatment in 68.5% (1253 of 1830). Predictors of EM clinician treatment of ASB versus no treatment included dementia, spinal cord injury, incontinence, urinary catheter, altered mental status, leukocytosis, and abnormal urinalysis. Once initiated by EM clinicians, 79% (993 of 1253) of patients remained on antibiotics for at least 3 days. Antibiotic treatment was associated with a longer length of hospitalization (mean 5.1 vs 4.2 days; relative risk = 1.16; 95% confidence interval, 1.08-1.23) and
CONCLUSIONS
CONCLUSIONS
Among hospitalized patients ultimately diagnosed with ASB, EM clinicians commonly initiated testing and treatment; most antibiotics were continued by inpatient clinicians. Antibiotic treatment was not associated with improved outcomes, whereas it was associated with prolonged hospitalization and CDI. For best impact, stewardship interventions must expand to the ED.
Identifiants
pubmed: 33324723
doi: 10.1093/ofid/ofaa537
pii: ofaa537
pmc: PMC7724506
doi:
Types de publication
Journal Article
Langues
eng
Pagination
ofaa537Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
Références
Open Forum Infect Dis. 2014 Jun 23;1(1):ofu019
pubmed: 25734092
JAMA. 2014 Oct 8;312(14):1438-46
pubmed: 25291579
J Hosp Med. 2016 Mar;11(3):181-4
pubmed: 26559929
Am J Med. 2014 Apr;127(4):255-7
pubmed: 24439075
JAMA Intern Med. 2017 Sep 1;177(9):1308-1315
pubmed: 28604925
Ann Intern Med. 2019 Oct 1;171(7_Suppl):S73-S74
pubmed: 31569221
Clin Infect Dis. 2017 Sep 15;65(6):910-917
pubmed: 28531289
Clin Infect Dis. 2019 May 2;68(10):e83-e110
pubmed: 30895288
Ann Intern Med. 2019 Aug 6;171(3):153-163
pubmed: 31284301
Emerg Med J. 2015 Jul;32(7):506
pubmed: 25336560
Am J Infect Control. 2014 Jun;42(6):653-8
pubmed: 24713596
J Emerg Med. 2016 Jul;51(1):25-30
pubmed: 27066953
Infect Control Hosp Epidemiol. 2019 May;40(5):522-527
pubmed: 30919799
Open Forum Infect Dis. 2017 Nov 20;4(4):ofx207
pubmed: 29226170
Emerg Med Clin North Am. 2018 Nov;36(4):853-872
pubmed: 30297009
J Antimicrob Chemother. 2019 Feb 1;74(2):515-520
pubmed: 30445465
JAMA Intern Med. 2019 Aug 26;:
pubmed: 31449295
J Community Hosp Intern Med Perspect. 2012 Jul 16;2(2):
pubmed: 23882368
Infect Control Hosp Epidemiol. 2014 Sep;35(9):1114-25
pubmed: 25111919
BMC Infect Dis. 2015 Jul 26;15:289
pubmed: 26209977
Infect Control Hosp Epidemiol. 2015 Apr;36(4):470-3
pubmed: 25782904
Multivariate Behav Res. 2011 May;46(3):399-424
pubmed: 21818162
Am J Infect Control. 2013 Oct;41(10):892-6
pubmed: 23541740
JAMA. 2019 Sep 24;322(12):1188-1194
pubmed: 31550038
BMC Geriatr. 2019 Feb 4;19(1):32
pubmed: 30717706
JAMA Surg. 2019 Jul 1;154(7):590-598
pubmed: 31017647
J Clin Microbiol. 2016 Feb;54(2):254-8
pubmed: 26659213
Antimicrob Resist Infect Control. 2018 Jan 8;7:4
pubmed: 29340148
Ann Pharmacother. 2017 Sep;51(9):774-790
pubmed: 28539060
BMJ Qual Saf. 2018 Feb;27(2):140-147
pubmed: 28468911
Neurosurgery. 2019 Nov 1;85(5):664-671
pubmed: 30335172
JAMA. 2017 Aug 15;318(7):607-608
pubmed: 28759678
JAMA Intern Med. 2014 Oct;174(10):1577-84
pubmed: 25133488
JAMA Intern Med. 2016 May 1;176(5):587-8
pubmed: 27019140