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Many patients with advanced cancer inappropriately treated for UTIs
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Study findings showed that many patients with advanced cancer who are transitioning to comfort measures are inappropriately treated for UTIs, often with broad-spectrum antimicrobials.
The patients often have asymptomatic bacteriuria or candiduria, suggesting that urine cultures should be restricted in this population, researchers said.
“Antimicrobial therapy in those receiving palliative care should be concordant with goals of care by promoting comfort and quality of life,” Rupak Datta MD, PhD, MPH, an infectious disease fellow at the Yale School of Medicine, and colleagues wrote. “However, antimicrobial therapy for asymptomatic bacteriuria conflicts with palliative goals of care if it provides no symptom relief and promotes adverse effects. Moreover, administering antimicrobials may cause pain and introduce additional infection risk.”
The study followed patients with advanced cancer aged at least 65 years who transitioned to comfort measures at the Yale-New Haven Hospital between July 1, 2014, and Nov. 31, 2016. Datta and colleagues categorized patient urine cultures three ways: no growth; bacteriuria or candiduria between 10,000 and 100,000 colony-forming units per milliliter (CFU/mL); or bacteriuria or candiduria with at least 100,000 CFU/mL.
They identified 300 patients with potential UTIs — 19 with symptoms and 281 without symptoms, as determined by the 2017 National Healthcare Safety Network (NHSN) symptomatic UTI criteria. Of those without symptoms, 21% (n = 59) had asymptomatic bacteriuria or candiduria and 14.2% (n = 40) were given inappropriate UTI-specific antimicrobial therapy for a total of 279 antimicrobial days.
Among patients who received inappropriate UTI-specific antimicrobial therapy, 35 had bacteriuria or candiduria and 35 did not express clinical features of UTI, according to Datta and colleagues. Ciprofloxacin (n = 12), fluconazole (n = 8), and piperacillin/tazobactam (n = 4) were the most commonly prescribed antibiotics.
According to the researchers, “bacteriuria or candiduria predicted antimicrobial therapy” — the incident rate ratios were 16.9 (95% CI, 6.0-47.4) in patients with counts between 10,000 and 100,000 CFU/mL and 27.9 (95% CI, 10.9-71.2) for at least 100,000 CFU/mL.
“Collectively, this study highlights a potential target of antimicrobial stewardship, namely, restricting urine culture orders in advanced cancer patients transitioning to comfort measures,” said study authors. – by Erin Michael
Disclosures: The authors report no relevant financial disclosures.
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