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Antimicrobial use for asymptomatic bacteriuria-First, do no harm.

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Antimicrobial misuse in asymptomatic bacteriuria (ASB) is common, particularly in men and those with poor functional status. This practice increases risks for re-hospitalizations and Clostridioides difficile infections (CDI).

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Area of Science:

  • Infectious Diseases
  • Clinical Pharmacy
  • Healthcare Quality Improvement

Background:

  • Asymptomatic bacteriuria (ASB) is often treated with antimicrobials, a practice with potential negative consequences.
  • Quantifying the frequency and impact of antimicrobial misuse in ASB is crucial for improving patient outcomes.

Purpose of the Study:

  • To identify predictors of antimicrobial misuse in patients with ASB.
  • To quantify the impact of this misuse on clinical outcomes, including re-hospitalizations and Clostridioides difficile infections (CDI).

Main Methods:

  • Retrospective analysis of adult patients with positive urine cultures in 2017.
  • Multivariable logistic regression to determine predictors and outcomes of antimicrobial use in ASB.
  • ASB defined by CDC criteria; exclusions included pregnant women and transplant recipients.

Main Results:

  • 40% of patients with positive urine cultures had ASB; 36% involved multidrug-resistant organisms (MDROs).
  • 29% of ASB patients received antimicrobials, with male sex and dependent functional status as key predictors.
  • Antimicrobial use was linked to increased re-hospitalizations and 90-day CDI incidence.

Conclusions:

  • Antimicrobial mistreatment of ASB is frequent, often involving MDROs.
  • Male sex and poor functional status predict inappropriate antimicrobial administration.
  • This practice significantly elevates the risk of re-hospitalizations and subsequent CDI.