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Antibiotics tied to longer hospital stay for patients with asymptomatic bacteriuria
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Inappropriate antibiotic treatment is common in hospitalized patients with asymptomatic bacteriuria, particularly among elderly patients with altered mental status, and it may lead to increased length of hospital stay, according to study results published in JAMA Internal Medicine.
Although hospitals have begun to address inappropriate antibiotic use for asymptomatic bacteriuria (ASB) through antimicrobial stewardship programs, many physicians still prescribe them unnecessarily, the study authors noted.
“Even when clinicians are knowledgeable, guideline-discordant practices persist owing to concern for adverse outcomes if ASB is not treated,” Lindsey A. Petty, MD, of the division of infectious diseases at the University of Michigan, and colleagues wrote.
To assess and identify factors associated with antibiotic treatment in patients with ASB, researchers conducted a retrospective cohort study using data from a consortium of 46 hospitals in Michigan. Patients who had positive urine cultures collected during hospitalization from Jan. 1, 2016, to Feb. 1, 2018, were included in the study.
A total of 2,733 patients with a median age of 77 years were included in the study. Of these patients, 82.7% of patients were given antibiotics for a median of 7 days.
Antibiotic treatment for ASB was significantly associated with older age (OR = 1.1 per 10-year increase; 95% CI, 1.02-1.18), dementia (OR = 1.57; 95% CI,1.15-2.13) and acutely altered mental status (OR = 1.93; 95% CI, 1.23-3.04).
Compared with no antibiotics, treatment with antibiotics was associated with longer hospital stays following urine testing (4 days vs. 3 days; RR = 1.37; 95% CI, 1.28-1.47).
According to the researchers, there were no differences in mortality, readmission, ED visits, or Clostridioides difficile infection between those who did and did not receive antibiotic treatment for ASB.
“Inappropriate antibiotic use has been associated with harm; these findings add to the growing body of literature supporting a less-is-more approach, especially in elderly patients who are at higher risk of experiencing adverse drug events,” Petty and colleagues wrote.
Based on the findings, the authors recommended that stewardship programs focus on improving to urine testing practices and management in elderly patients with altered mental status. – by Erin Michael
Disclosures: Petty reported grants from Blue Cross Blue Shield of Michigan during the conduct of the study. Please see study for all other authors’ relevant financial disclosures.