High Prevalence Of Asymptomatic Bacteriuria Research Articles

Urine biomarkers individually and as a consensus model show high sensitivity and specificity for detecting UTIs

BackgroundCurrent diagnoses of urinary tract infection (UTI) by standard urine culture (SUC) has significant limitations in sensitivity, especially for fastidious organisms, and the ability to identify organisms in polymicrobial infections. The significant rate of both SUC “negative” or “mixed flora/contamination” results in UTI cases and the high prevalence of asymptomatic bacteriuria indicate the need for an accurate diagnostic test to help identify true UTI cases. This study aimed to determine if infection-associated urinary biomarkers can differentiate definitive UTI cases from non-UTI controls.MethodsMidstream clean-catch voided urine samples were collected from asymptomatic volunteers and symptomatic subjects ≥ 60 years old diagnosed with a UTI in a urology specialty setting. Microbial identification and density were assessed using a multiplex PCR/pooled antibiotic susceptibility test (M-PCR/P-AST) and SUC. Three biomarkers [neutrophil gelatinase-associated lipocalin (NGAL), and Interleukins 8 and 1β (IL-8, and IL-1β)] were also measured via enzyme-linked immunosorbent assay (ELISA). Definitive UTI cases were defined as symptomatic subjects with a UTI diagnosis and positive microorganism detection by SUC and M-PCR, while definitive non-UTI cases were defined as asymptomatic volunteers.ResultsWe observed a strong positive correlation (R2 > 0.90; p < 0.0001) between microbial density and the biomarkers NGAL, IL-8, and IL-1β for symptomatic subjects. Biomarker consensus criteria of two or more positive biomarkers had sensitivity 84.0%, specificity 91.2%, positive predictive value 93.7%, negative predictive value 78.8%, accuracy 86.9%, positive likelihood ratio of 9.58, and negative likelihood ratio of 0.17 in differentiating definitive UTI from non-UTI cases, regardless of non-zero microbial density. NGAL, IL-8, and IL-1β showed a significant elevation in symptomatic cases with positive microbe identification compared to asymptomatic cases with or without microbe identification. Biomarker consensus exhibited high accuracy in distinguishing UTI from non-UTI cases.ConclusionWe demonstrated that positive infection-associated urinary biomarkers NGAL, IL-8, and IL-1β, in symptomatic subjects with positive SUC and/or M-PCR results was associated with definitive UTI cases. A consensus criterion with ≥ 2 of the biomarkers meeting the positivity thresholds showed a good balance of sensitivity (84.0%), specificity (91.2%), and accuracy (86.9%). Therefore, this biomarker consensus is an excellent supportive diagnostic tool for resolving the presence of active UTI, particularly if SUC and M-PCR results disagree.

Diagnostic accuracy of urine biomarkers for urinary tract infection in older women: a case-control study

ObjectivesUrinary tract infection (UTI) is common among older women. However, diagnosis is challenging because of frequent chronic lower urinary tract symptoms, cognitive impairment, and a high prevalence of asymptomatic bacteriuria (ASB). Current urine diagnostics lack specificity, leading to unnecessary treatment and antimicrobial resistance. This study aimed to evaluate the diagnostic accuracy of 12 urine biomarkers for diagnosing UTI in older women. MethodsIn this case-control study, cases were women ≥65 years with ≥2 new-onset lower urinary tract symptoms, pyuria, and one uropathogen ≥104 CFU/mL. Controls were asymptomatic and classified as ASB (one uropathogen ≥105 CFU/mL), negative culture, or mixed flora. Urine biomarker concentrations were measured through liquid chromatography-mass spectrometry and ELISA. Diagnostic accuracy parameters of individual biomarkers and a biomarker model were derived from receiver operating characteristic curves. ResultsWe included 162 community-dwelling and institutionalized older women. Five urine inflammatory biomarkers demonstrated high discriminative ability (area under the curve ≥0.80): interleukin 6, azurocidin, neutrophil gelatinase-associated lipocalin, tissue inhibitor of metalloproteinases 2, and C-X-C motif chemokine 9. Azurocidin exhibited the highest diagnostic accuracy (sensitivity 86% [95% CI 75%–93%] and specificity 89% [95% CI 82%–94%] at 16.7 ng/mmol creatinine). A combined biomarker and pyuria model showed improved diagnostic accuracy in patients with UTI and ASB, compared with pyuria alone. DiscussionWe identified several urine biomarkers that accurately differentiated older women with UTI from asymptomatic women, including ASB. These findings represent a potential advancement towards improved diagnostics for UTI in older women and warrant validation in a diverse population.

Asymptomatic Bacteriuria and Antibiogram of Isolates Among Diabetic Patients in Calabar, Nigeria

Asymptomatic bacteriuria is the presence of bacteria in the urine of an individual without any symptom of urinary tract infection. This has been widely observed in diabetic patients and could be detrimental to their health if not effectively managed. This study was to identify the pathogens associated with asymptomatic bacteriuria among patients with diabetes and the antibiogram of those isolates in Calabar. Blood samples were collected for the determination of fasting blood sugar levels using glucometer. Bacterial isolations were done through urine culture and antibiogram were tested in all urine samples of the diabetic patients in this study. The prevalence of bacteriuria in this study was 26.0%. Participants aged, 41-50 years were highest both in blood sugar level (12.3+/-4.38mmol/L) and infection rate (37.5%, 18/48). Females had lower blood sugar (10.9+/-3.370mmol/L) than the males (11.3+/-4.46mmol/L) while the males had less infection rate (22.4%, 22/98) than the females (29.4%, 30/102). Escherichia coli, 46.2% (24/52) had the highest distribution while Proteus spp. 11.5% (6/52) had the least distribution. Ciprofloxacin was the most sensitivity (100%) while Amoxicillin was the most resistant (38%). There was a high prevalence of asymptomatic bacteriuria in this study. The most commonly observed organisms were Escherichia coli. Ciprofloxacin was the most sensitive antibiotics and there was a widespread antibiotic resistance in this study. It is therefore recommended that screening among diabetic patients for urinary tract infections, sensitization and strategies to promote effective drug usage be encouraged.

Current Pyuria Cutoffs Promote Inappropriate Urinary Tract Infection Diagnosis in Older Women.

Pre-existing lower urinary tract symptoms (LUTS), cognitive impairment, and the high prevalence of asymptomatic bacteriuria (ASB) complicate the diagnosis of urinary tract infection (UTI) in older women. The presence of pyuria remains the cornerstone of UTI diagnosis. However, >90% of ASB patients have pyuria, prompting unnecessary treatment. We quantified pyuria by automated microscopy and flowcytometry to determine the diagnostic accuracy for UTI and to derive pyuria thresholds for UTI in older women. Women ≥65 years with ≥2 new-onset LUTS and 1 uropathogen ≥104 colony-forming units (CFU)/mL were included in the UTI group. Controls were asymptomatic and classified as ASB (1 uropathogen ≥105 CFU/mL), negative culture, or mixed flora. Patients with an indwelling catheter or antimicrobial pretreatment were excluded. Leukocyte medians were compared and sensitivity-specificity pairs were derived from a receiver operating characteristic curve. We included 164 participants. UTI patients had higher median urinary leukocytes compared with control patients (microscopy: 900 vs 26 leukocytes/µL; flowcytometry: 1575 vs 23 leukocytes/µL; P < .001). Area under the curve was 0.93 for both methods. At a cutoff of 264 leukocytes/µL, sensitivity and specificity of microscopy were 88% (positive and negative likelihood ratio: 7.2 and 0.1, respectively). The commonly used cutoff of 10 leukocytes/µL had a poor specificity (36%) and a sensitivity of 100%. The degree of pyuria can help to distinguish UTI in older women from ASB and asymptomatic controls with pyuria. Current pyuria cutoffs are too low and promote inappropriate UTI diagnosis in older women. Clinical Trials Registration. International Clinical Trials Registry Platform: NL9477 (https://trialsearch.who.int/Trial2.aspx?TrialID=NL9477).

What is the Diagnostic Accuracy of Novel Urine Biomarkers for Urinary Tract Infection?

Urinary tract infection (UTI) affects half of women at least once in their lifetime. Current diagnosis involves urinary dipstick and urine culture, yet both methods have modest diagnostic accuracy, and cannot support decision-making in patient populations with high prevalence of asymptomatic bacteriuria, such as older adults. Detecting biomarkers of host response in the urine of hosts has the potential to improve diagnosis. To synthesise the evidence of the diagnostic accuracy of novel biomarkers for UTI, and of their ability to differentiate UTI from asymptomatic bacteriuria. A systematic review. We searched MEDLINE, EMBASE, CINAHL and Web of Science for studies of novel biomarkers for the diagnosis of UTI. We excluded studies assessing biomarkers included in urine dipsticks as these have been well described previously. We included studies of adult patients (≥16 years) with a suspected or confirmed urinary tract infection using microscopy and culture as the reference standard. We excluded studies using clinical signs and symptoms, or urine dipstick only as a reference standard. Quality appraisal was performed using QUADAS-2. We summarised our data using point estimates and data accuracy statistics. We included 37 studies on 4009 adults measuring 66 biomarkers. Study quality was limited by case-control design and study size; only 4 included studies had a prospective cohort design. IL-6 and IL-8 were the most studied biomarkers. We found plausible evidence to suggest that IL-8, IL-6, GRO-a, sTNF-1, sTNF-2 and MCR may benefit from more rigorous evaluation of their potential diagnostic value for UTI. There is insufficient evidence to recommend the use of any novel biomarker for UTI diagnosis at present. Further evaluation of the more promising candidates, is needed before they can be recommended for clinical use.

INVESTIGATION OF ASYMPTOMATIC BACTERIURIA IN A GROUP OF IRAQI PATIENTS WITH DIABETES MELLITUS TYPE 2 IN BAGHDAD CITY, IRAQ

Several studies have indicated that asymptomatic bacteriuria (ASB) is a frequent condition in diabetics and may lead to more severe urinary tract infections (UTIs). This study was conducted to determine the frequency of ASB in patients with type 2 diabetes mellitus as well as the identification of the bacterial etiology of ASB in addition to the antibiotic sensitivity profile in a group of Iraqi patients. A total of 100 individuals were included in this study, 50 diabetic outpatients and 50 non-diabetics as a control group. Mid-stream urine specimens were collected from patients and tested using the urine dipstick test, microscopy and culture tests. It was shown that 90% of diabetic patients were culture positive and 10% were culture negative for bacteria. On the other hand, it was observed that 90% of non-diabetics had no bacterial growth in their urine specimens. The most isolated organisms were Staphylococcus aureus (34%), Enterobacter aerogenes (28%), and Klebsiella spp (10%). It was observed that S. aureus was completely resistant to ampicillin (100%), while only 30% of these isolates were resistant to ciprofloxacin. It was noted that S. aureus was the most isolated in the study, which is a clear change in the spectrum of the causative agent of these cases. Given the high prevalence of ASB in patients with type 2 diabetes, this study recommends that the diagnostic program for diabetic patients should include bacterial culture of their urine specimens to determine the antimicrobial resistance of isolated bacteria.

Protocolo diagnóstico y terapéutico de la infección urinaria en el paciente mayor

Urinary tract infections (UTIs) are, after respiratory infections, the most common infectious disease in elderly patients. Their form of presentation ranges from asymptomatic bacteriuria to cystitis, pyelonephritis, or urinary sepsis. The diagnosis is based on clinical suspicion and the detection of pyuria and a urine culture with significant bacteriuria. In geriatric patients, the disease's often atypical presentation and the high prevalence of asymptomatic bacteriuria hinder its diagnosis. Asymptomatic bacteriuria is the colonization of the urinary tract by bacteria and must be differentiated from a symptomatic UTI, as it does not require treatment. When choosing empirical antibiotic treatment, the possible adverse effects, previous microbiological isolations, and local resistance rate must be taken into account.

938 ‘TO DIP OR NOT TO DIP’: IMPROVING THE MANAGEMENT OF LOWER URINARY TRACT INFECTIONS IN OLDER PEOPLE

Abstract Introduction I completed two PDSA cycles of a Quality Improvement project, from 2019 to 2021, aimed at improving the management of lower urinary tract infections (UTIs) in older people. My interest in this subject was instilled after it was brought to my attention that Public Health England (PHE) guidelines were revised in 2018 to state that urine dipsticks tests (UDTs) should not be used as a diagnostic aid in any patient over the age of 65 years. I became concerned that geriatric patients may be misdiagnosed and mistreated with unnecessary antibiotics, given the high prevalence of asymptomatic bacteriuria in this population. Method I sampled patients diagnosed with a urinary tract infection in the Emergency Department of the Queen Elizabeth Hospital, Gateshead over a 7-day period. I extracted medical notes of patients prescribed one of 7 antibiotics, then excluded patients under 65-years-old and those treated for an infection outside the lower urinary tract. Next, I established whether a UDT was used as a diagnostic aid using the medical notes. Results Before and after intervention: my initial findings revealed that a UDT was performed in 100% patients diagnosed with a UTI (i.e. no cases were in line with best practice). My first educational intervention involved sharing the revised PHE guidelines with staff via an interactive teaching-session, following this I found that a UDT was performed in 62% patients. My next intervention was a flow-chart entitled ‘to dip or not to dip’ pasted in the ED. Following this final intervention, I found that 27% cases were in line with best practice (a UDT was used in 73% cases). Conclusion With this modest improvement, I concluded that my recommendations reduced the number of over 65-year-old patients undergoing unnecessary UDTs as part of their diagnostic work-up.

P02 To dip or not to dip? Improving the management of lower urinary tract infections in older patients

IntroductionPHE guidelines were revised in 2018 to state that urine dipsticks tests (UDTs) should not be used as a diagnostic aid in any patient over the age of 65 years.The high prevalence of asymptomatic bacteriuria in the elderly population is widely acknowledged however the adherence to the above guidelines is unclear.My aim was to investigate whether geriatric patients are being misdiagnosed with urinary tract infections (UTIs) and mistreated with unnecessary antibiotics, given the high prevalence of asymptomatic bacteriuria in this population.MethodsI sampled patients diagnosed with a UTI in the Emergency Department of the Queen Elizabeth Hospital, Gateshead over a 7 day period. I extracted medical notes of patients prescribed one of 7 antibiotics, then excluded patients under 65 years old and those treated for an infection outside the lower urinary tract. Next, I established whether a UDT was used as a diagnostic aid using the medical notes. Using this methodology, I repeated my data collection and completed two PDSA cycles of this Quality Improvement project, from 2019 to 2021.Figure 1.Initial results in November 2019: in 100% cases a UDT was used to diagnose a lower UTI: 0% cases in line with best practice.Figure 2.Repeat results in May 2021: in 83% cases a UDT was used to diagnose a lower UTI: 27% cases in line with best practice.ResultsMy initial findings revealed that a UDT was performed in 100% patients diagnosed with a UTI (i.e. no cases were in line with best practice). My first educational intervention involved sharing the revised PHE guidelines with staff via an interactive teaching-session. Following this step, I found that a UDT was performed in 62% patients. My next intervention was a flow chart entitled ‘to dip or not to dip’ pasted in the ED. After this second intervention, I found that 27% cases were in line with best practice (a UDT was used in 73% cases).ConclusionsWith this modest improvement, I concluded that my recommendations reduced the number of over 65-year-old patients undergoing unnecessary UDTs as part of their diagnostic work-up.

Asymptomatic Bacteriuria in pregnant women attending a tertiary hospital in northern India: prevalence, risk factors, causative organisms and antimicrobial sensitivity pattern

Background: Asymptomatic bacteriuria is common and can lead to adverse foetal and maternal outcomes.&#x0D; Aims and Objective: The current study aimed to estimate the prevalence of asymptomatic bacteriuria (ABU), its associated risk factors, bacterial isolates and antimicrobial sensitivity pattern in pregnant women attending Outpatient department (services in a tertiary hospital in India.&#x0D; Materials and Methods: This was a hospital-based cross-sectional study among asymptomatic women coming for routine antenatal check-ups to obstetrics OPD of a teaching hospital in Northern India. Samples were collected, processed and antimicrobial sensitivity done as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Data was analysed and p value below 0.05 was considered as statistically significant.&#x0D; Results: Overall 247 pregnant women were included in the study with a mean age of 25.9 ± 3.1. The overall prevalence of asymptomatic bacteriuria was 18.6%. The most common isolates responsible for ABU were E. Coli (48%), S Aureus (23%), K. pneumonia (12%), Pseudomonas (6%), Enterococcus (6%), Proteus (5%). Gram-negative isolates were mostly sensitive to Fosfomycin, Meropenem, Piperacillin + Tazobactum whereas gram-positive isolates were usually sensitive to Fosfomycin, Vancomycin and Linezolid Most isolates were resistant to Co-amoxiclav, Ciprofloxacin, and Nitrofurantoin.&#x0D; Conclusion: Considering the high prevalence of ABU and its association with adverse maternal and foetal outcomes, urine culture should be included in routine investigations being offered to pregnant women. Gram-negative bacteria were the primary causative agents with Fosfomycin, Meropenem and Ceftazidime showing high level of efficacy against the pathogens.

Asymptomatic Bacteriuria and its Antibiotic Susceptibility Patterns among Pregnant Women in a Tertiary Care Center

Background: Occurrence of asymptomatic bacteriuria (ASB) in 2–11% of pregnant women is a major predisposition to the development of pyelonephritis, which is associated with significant maternal and fetal complications. Aim : The aim of this study was to determine the prevalence of ASB among pregnant women, to report the most common organisms causing ASB, along with their antibiotic sensitivity patterns. Materials and Methods A total of 250 asymptomatic pregnant women were screened for ASB by urine culture by standard microbiological procedures and the antibiotic sensitivity patterns recorded. Results Of the 250 pregnant women screened, 27 (10.8%) had ASB. The most common organism was Escherichia coli (52%) followed by Klebsiella pneumoniae and Staphylococcus aureus (19%). Majority of the uropathogens were found to be sensitive to nitrofurantoin (81%) and ciprofloxacin (63%). Conclusions: The high prevalence of ASB among pregnant women (10.8%) in our center demands the need for routine screening of the pregnant women and treat them appropriately, to reduce the risk of complications associated with ASB.

Deceptive Urine Studies and Inappropriate Antibiotic Use in Geriatric Psychiatry: The Impact of Bundled Interventions.

Background:Indiscriminate orders for urinalysis and urine cultures (UC) drive inappropriate antibiotic treatment (Abx), especially in older adults with mental health disorders. Lack of data regarding the prevalence of and treatment for infections in acute geriatric psychiatric units (GPU) motivated us to initiate this project.Aim:Our goal was to improve urine test utilization and reduce unnecessary Abx for asymptomatic bacteriuria (ASB) and contaminated UC. Methods: This retrospective review and prospective evaluation of bundled interventions was conducted in a 22- bed GPU in a community-based teaching hospital. Four hundred twenty-seven (427) patient records were reviewed for Abx and indication and 157 patients were assessed for the impact of bundled interventions.Results:Near 27% received Abx, primarily for a misdiagnosed urinary tract infection. Only 20% met clinical criteria; 80% were unnecessarily treated for ASB or contaminated cultures. Over two-thirds of the Abx consisted of fluoroquinolones or trimethoprim-sulfamethoxazole, neither of which are recommended due to adverse events and/or resistance. The impact of bundled interventions was marginally effective.Conclusion:Urinalysis and UC are indiscriminately ordered in older adults, resulting in inappropriate Abx with non-recommended agents. Urinalysis should not be a requirement for admission in asymptomatic patients given the high prevalence of ASB and pyuria in older adults. There is an opportunity for more collaboration within referring networks to standardize best practice.

Prevalence of Asymptomatic Bacteriuria and Antibiotic Susceptibility Patterns of Bacterial Isolates among Cancer Patients and Healthy Blood Donors at the University of Gondar Specialized Hospital.

Background Urinary tract infections are the common types of infections in the community and health care settings. Despite the widespread availability of antibiotics, urinary tract infection remains a worldwide therapeutic problem. It is a continuous and significant problem in cancer patients. Methods A hospital-based comparative cross-sectional study was conducted on 240 study participants from January to June 2019. Sociodemographic data were collected by a predesigned questionnaire and midstream urine samples collected using simple random sampling technique by using clean, sterile plastic cups and then inoculated onto CLED agar plates and incubated at 37°C for 24 hours. Urine culture was considered significant bacteriuria when colony forming units ≥105/mL of voided urine and a single pure colony suspended in nutrient broth and then subcultured onto a blood agar plate and MacConkey agar plate, incubated at 37°C for 24 hours for identification. Identification was done by using standard microbiological methods. Modified Kirby–Bauer disk diffusion technique was applied for antimicrobial susceptibility testing in accordance with CLSI 2018 criteria. Data were entered, cleared, and checked using Epi Info version 7 and exported to SPSS version 20 for analysis. The results were displayed using tables and figures. p value <0.05 at 95% CI was considered as statistically significant. Results The overall prevalence of asymptomatic bacteriuria in cancer patients was 23.3% while 6.7% in apparently healthy blood donors. E. coli (32.1%) was the commonest isolated uropathogenic bacteria followed by Klebsiella species (25.0%), S. aureus (21.4%), Enterococcus species (10.7%), Serratia species (7.1%), and Enterobacter aerogenes (3.6%) in cancer patients. In apparently healthy blood donors, E. coli, Klebsiella species, and S. aureus were isolated from 75%, 12.5%, and 12.5%, respectively. Most Gram-negative bacteria were more sensitive to ceftazidime, cefoxitin, nalidixic acid, nitrofurantoin, norfloxacin, ciprofloxacin, and tobramycin, whereas highly resistant to ampicillin, penicillin, tetracycline, and ceftazidime. S. aureus isolates were 100% susceptible to nitrofurantoin. Conclusions This study showed a high prevalence of asymptomatic bacteriuria among cancer patients (23.3%) compared to apparently healthy blood donors (6.7%). E. coli was isolated predominately. Nitrofurantoin and ciprofloxacin should be used to treat asymptomatic bacteriuria in the study area.

A Statewide Program to Improve Management of Suspected Urinary Tract Infection in Long-Term Care.

Suspected urinary tract infection (UTI) is the most common indication for antibiotic use in long-term care (LTC). Due to the high prevalence of asymptomatic bacteriuria, for which antibiotics are not warranted, these antibiotics are frequently unnecessary. We implemented a collaborative quality improvement program to improve the management of suspected UTI in LTC residents by increasing awareness of current guidelines, with a focus on decreasing treatment in the absence of symptoms. Two separate collaboratives included workshops, webinars, and coaching calls. A total of 31 facilities participated in the first collaborative, with 17 submitting sufficient data for analysis and 34 in the second, with data analyzed from 25. Facilities reported monthly numbers of urine cultures, UTI diagnoses, Clostridioides difficile infections (CDIs), and resident days. When comparing the baseline period to the first collaborative period, the intercollaborative period to the second collaborative period, and the first collaborative period to the second, the incident rate ratios (95% confidence intervals) were 0.74 (0.68-0.81), 0.83 (0.73-0.94), and 0.63 (0.57-0.69), respectively, for urine culturing rate; 0.73 (0.64-0.83), 0.86 (0.70-1.05), and 0.60 (0.51-0.69), respectively, for UTI diagnosis rate; and 0.56 (0.40-0.82), 1.61 (0.71-4.14), and 0.45 (0.27-0.74), respectively, for CDI rate. The program we implemented was associated with reductions in urine cultures, UTI diagnosis, and CDI; and it suggests that this type of intervention can promote appropriate management of UTI in the LTC setting. J Am Geriatr Soc 68:62-69, 2019.

Asymptomatic bacteriuria in older adults: the most fragile women are prone to long-term colonization

BackgroundThe diagnosis of urinary tract infections (UTIs) in institutionalized older adults is often based on vague symptoms and a positive culture. The high prevalence of asymptomatic bacteriuria (ABU), which cannot be easily discriminated from an acute infection in this population, is frequently neglected, leading to a vast over-prescription of antibiotics. This study aimed to identify subpopulations predisposed to transient or long-term ABU.MethodsResidents in a long-term care facility were screened for ABU. Mid-stream urine samples were collected during two sampling rounds, separated by 10 weeks, each consisting of an initial and a confirmative follow-up sample.ResultsABU occurred in approximately 40% of the participants and was mostly caused by Escherichia coli. Long-term ABU (> 3 months) was found in 30% of the subjects. The frailest women with urinary incontinence and dementia had drastically increased rates of ABU and especially long-term ABU. ABU was best predicted by a scale describing the functional independence of older adults.ConclusionsInstitutionalized women with incontinence have ABU prevalence rates of about 80% and are often persistent carriers. Such prevalence rates should be considered in clinical decision making as they devalue the meaning of a positive urine culture as a criterion to diagnose UTIs. Diagnostic strategies are urgently needed to avoid antibiotic overuse and to identify patients at risk to develop upper UTI.

Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America.

Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.

Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America.

Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.

LO15: Treatment of asymptomatic bacteriuria in elderly patients with delirium: a systematic review

Introduction: It is typical to look for UTI in delirious elderly patients, despite a high prevalence of asymptomatic bacteriuria (ASB) in this population. A common presentation of infection is delirium, which often has a non-specific and multifactorial etiology. Therefore, when bacteriuria is present with delirium in the absence of urinary symptoms, physicians prescribe antibiotics for the suspected UTI-induced delirium. We set to determine whether antibiotic treatment in the elderly presenting with delirium in the presence of ASB resulted in resolution of delirium. Methods: Literature searches were performed in MEDLINE, EMBASE, CINAHL and Cochrane Library. Abstracts were independently reviewed by two authors for decision to include for full-text review. Inclusion criteria included female gender, &gt;65 years of age, presenting in an acute care setting with delirium and ASB. The primary outcome was resolution of delirium. The secondary outcomes were mortality, frequency of side effects from antibiotics, length of hospital stay and readmission for delirium. Results: 930 abstracts published from 1946-2017 were screened, and 42 were included for full text review. No studies were eligible for inclusion in the systematic review, as none addressed the primary outcome. One study addressed the outcomes of poor functional recovery after delirium and the rate of improvement of delirium symptoms after presentation of delirium with ASB. Conclusion: Even though current guidelines recommend against treatment of ASB, no guideline states whether ASB should be treated in elderly patients with delirium. Little evidence exists to elucidate whether treating delirious patients with ASB results in improvement in outcomes. Future studies should focus on demonstrating the relationship between resolution of delirium with antibiotic treatment. This will clarify whether delirium is a true symptom of ASB and whether treatment results in faster resolution of delirium.

Research progress of asymptomatic bacteriuria before arthroplasty: A systematic review.

A high prevalence of asymptomatic bacteriuria exists in patients prior to arthroplasty, and urinary tract infection is considered to be a source of postoperative superficial wound and prosthetic joint infections. There is no consensus whether to screen for and treat asymptomatic bacteriuria before arthroplasty. To summarize the association between asymptomatic bacteriuria and complications after arthroplasty and to evaluate the clinical benefits of treating asymptomatic bacteriuria prior to arthroplasty. We systematically searched PubMed, Embase, and the Cochrane Library to retrieve potentially eligible articles. By screening the titles and abstracts of retrieved records and then reading the full texts of the remaining papers, we finally included 8 English-language articles in this systematic review. Asymptomatic bacteriuria prior to arthroplasty is significantly associated with an increased occurrence of postoperative prosthetic joint and superficial wound infections. However, there is little evidence for direct or hematogenous seeding of urinary infections, and treating asymptomatic bacteriuria before arthroplasty did not decrease the incidence of postoperative infectious complications. Asymptomatic bacteriuria is not a contraindication for arthroplasty, and the practice of routine preoperative screening for and treatment of asymptomatic bacteriuria should not be continued.

Antimicrobial Stewardship Strategies in Nursing Homes: Urinary Tract Infections

Deciding if a nursing home resident should receive an antimicrobial for a suspected urinary tract infection is challenging. One of the most frequently reported reasons nursing home staff suspect presence of a urinary tract infection (UTI) is change in a resident’s mental status. However, a change in mental status may be due to numerous causes, such as presence of underlying conditions like dementia, or reaction to a new medication. The evaluation for a UTI when a resident experiences change in mental status is further confounded by the high prevalence of asymptomatic bacteriuria, which leads to positive urine cultures in nursing home residents. Various organizations recommend testing and/or treating residents for UTIs only when they have presence of localizing signs and symptoms in order to reduce prescribing antimicrobials to residents with asymptomatic bacteriuria. Unnecessary antimicrobial use is contributing to the emergence of multidrug-resistant organisms and the increase in Clostridium difficile infections. Antimicrobial stewardship programs take measures to reduce inappropriate antimicrobial use including monitoring antibiotic use for residents with suspected urinary tract infections and reviewing the use of diagnostic tests as a driver for antibiotic use. Furthermore, additional methods such as educating nursing home staff on hand hygiene, urinary catheter use, and criteria for identifying signs and symptoms of a urinary tract infection along with discussing and including antimicrobial use in end-of-life goals may also aid in reducing antimicrobial use for UTIs. However, determining when a resident should be treated for a urinary tract infection is difficult, and more research is needed to help clinicians distinguish nursing home residents who have bacteriuria from the residents who have true urinary tract infections.