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- Title
Bacteremia From a Presumed Urinary Source in Hospitalized Adults With Asymptomatic Bacteriuria.
- Authors
Advani, Sonali D.; Ratz, David; Horowitz, Jennifer K.; Petty, Lindsay A.; Fakih, Mohamad G.; Schmader, Kenneth; Mody, Lona; Czilok, Tawny; Malani, Anurag N.; Flanders, Scott A.; Gandhi, Tejal N.; Vaughn, Valerie M.
- Abstract
This cohort study evaluates prevalence and factors associated with bacteremia from a presumed urinary source in inpatients with asymptomatic bacteriuria with or without altered mental status. Key Points: Question: What is the prevalence of bacteremia from a presumed urinary source in hospitalized patients with asymptomatic bacteriuria (ASB)? Findings: In this 5-year, 68-hospital cohort study of 11 590 hospitalized patients with ASB, only 1.4% developed bacteremia from a presumed urinary source, while 72.2% received empiric antibiotic therapy for urinary tract infection. In the 2126 patients with bacteriuria with altered mental status but no systemic signs of infection, only 0.7% developed bacteremia from a presumed urinary source. Meaning: These findings suggest that bacteremia from a presumed urinary source was rare in patients with ASB, even those presenting with altered mental status. Importance: Guidelines recommend withholding antibiotics in asymptomatic bacteriuria (ASB), including among patients with altered mental status (AMS) and no systemic signs of infection. However, ASB treatment remains common. Objectives: To determine prevalence and factors associated with bacteremia from a presumed urinary source in inpatients with ASB with or without AMS and estimate antibiotics avoided if a 2% risk of bacteremia were used as a threshold to prompt empiric antibiotic treatment of ASB. Design, Setting, and Participants: This cohort study assessed patients hospitalized to nonintensive care with ASB (no immune compromise or concomitant infections) in 68 Michigan hospitals from July 1, 2017, to June 30, 2022. Data were analyzed from August 2022 to January 2023. Main Outcomes and Measures: The primary outcome was prevalence of bacteremia from a presumed urinary source (ie, positive blood culture with matching organisms within 3 days of urine culture). To determine factors associated with bacteremia, we used multivariable logistic regression models. We estimated each patient's risk of bacteremia and determined what percentage of patients empirically treated with antibiotics had less than 2% estimated risk of bacteremia. Results: Of 11 590 hospitalized patients with ASB (median [IQR] age, 78.2 [67.7-86.6] years; 8595 female patients [74.2%]; 2235 African American or Black patients [19.3%], 184 Hispanic patients [1.6%], and 8897 White patients [76.8%]), 8364 (72.2%) received antimicrobial treatment for UTI, and 161 (1.4%) had bacteremia from a presumed urinary source. Only 17 of 2126 patients with AMS but no systemic signs of infection (0.7%) developed bacteremia. On multivariable analysis, male sex (adjusted odds ratio [aOR], 1.45; 95% CI, 1.02-2.05), hypotension (aOR, 1.86; 95% CI, 1.18-2.93), 2 or more systemic inflammatory response criteria (aOR, 1.72; 95% CI, 1.21-2.46), urinary retention (aOR, 1.87; 95% CI, 1.18-2.96), fatigue (aOR, 1.53; 95% CI, 1.08-2.17), log of serum leukocytosis (aOR, 3.38; 95% CI, 2.48-4.61), and pyuria (aOR, 3.31; 95% CI, 2.10-5.21) were associated with bacteremia. No single factor was associated with more than 2% risk of bacteremia. If 2% or higher risk of bacteremia were used as a cutoff for empiric antibiotics, antibiotic exposure would have been avoided in 78.4% (6323 of 8064) of empirically treated patients with low risk of bacteremia. Conclusions and Relevance: In patients with ASB, bacteremia from a presumed urinary source was rare, occurring in less than 1% of patients with AMS. A personalized, risk-based approach to empiric therapy could decrease unnecessary ASB treatment.
- Subjects
MICHIGAN; ANTIBIOTICS; BLOOD; URINARY tract infections; SUPPURATION; LEUKOCYTE count; UNNECESSARY surgery; RESEARCH funding; HOSPITAL care; MENTAL illness; BACTEREMIA; TERMINATION of treatment; SEX distribution; SYSTEMIC inflammatory response syndrome; FATIGUE (Physiology); LOGISTIC regression analysis; PROBABILITY theory; BACTERIURIA; HOSPITALS; DESCRIPTIVE statistics; MULTIVARIATE analysis; URINE; CHI-squared test; MANN Whitney U Test; LONGITUDINAL method; CELL culture; ODDS ratio; URINALYSIS; RETENTION of urine; STATISTICS; CONFIDENCE intervals; LEUCOCYTE disorders; HYPOTENSION; DISEASE risk factors; DISEASE complications; SYMPTOMS
- Publication
JAMA Network Open, 2024, Vol 7, Issue 3, pe242283
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.2283