1685. Inappropriate Treatment of Asymptomatic Bacteriuria in Elderly Patients: A Quality Improvement Study

Abstract

BackgroundAsymptomatic bacteriuria is often misdiagnosed as Urinary Tract Infection (UTI) in elderly patients. Studies suggest that 15-30% of males and 25-50% of females have asymptomatic bacteriuria. We wanted to estimate the percentage of elderly patients who are treated for UTI at our facility and if treatment was appropriate. The goal was to provide the staff with an educational opportunity and help decide if more antibiotic restriction policies would be beneficial.MethodsA retrospective study of patients > 65 years of age who were started on antibiotics for presumed UTI at a single medical center between 7/2018 and 12/2018. Reviewed data included demographics, admitting diagnosis, presence or absence of symptoms of UTI and urine culture results. The data was presented at educational conferences and at antimicrobial stewardship meetings in our facility.Results: 234 patients were started on antibiotics on the basis of pyuria on admission. Of these, only 47% (n=110/234) had symptoms suggestive of UTI. Positive urine cultures were more common in symptomatic patients (n=93/110) compared with asymptomatic patients (n=47/80).In addition, ninety patients had a change in mental status on presentation and were started on antibiotics for suspected UTI. Approximately one third of these patients had eventual negative urine cultures.Conclusion: Elderly patients with pyuria and asymptomatic bacteriuria represent a diagnostic challenge due to their inability to vocalize signs or symptoms of UTI. In addition, a percentage of patients who are asymptomatic and admitted for another reason were often started on antibiotics inappropriately on the basis of pyuria alone. Studies have shown that treating asymptomatic bacteriuria does not add a mortality benefit or lower risk of infection. The CDC emphasizes the importance of assessing for clinical symptoms of UTI before treatment is considered.Our study highlights the importance of provider education in the management of asymptomatic bacteriuria in elderly patients. We also feel that antibiotic restriction policies may limit use of antibiotics for asymptomatic bacteriuria. This would in turn improve patient outcomes and decrease incidence of clostridium difficile associated colitis.Disclosures All Authors: No reported disclosures