Clinical outcomes associated with guideline-discordant management of asymptomatic bacteriuria and urinary tract infection in hospitalized patients with neurogenic bladder.
Clinical outcomes associated with guideline-discordant management of asymptomatic bacteriuria and urinary tract infection in hospitalized patients with neurogenic bladder.
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DOI：
10.1017/ash.2022.348
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Evans, Charlesnika T
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作者：
Fitzpatrick, Margaret A;Wirth, Marissa;Nguyen, Jimmy;Suda, Katie J;Weaver, Frances M;Burns, Stephen;Collins, Eileen;Safdar, Nasia;Patel, Ursula;Evans, Charlesnika T
比较神经源性膀胱（NB）住院患者中无症状菌尿（ASB）和尿路感染（UTI）适当和不适当治疗的临床结局。多中心、回顾性队列。这项研究在4家退伍军人事务医院进行。该研究包括2017年1月1日至2018年12月31日期间因脊髓损伤或疾病（SCI/D），多发性硬化症（MS）或帕金森病（PD）住院的NB退伍军人，诊断为ASB或UTI。在病历回顾中，我们根据国家指南将ASB和UTI诊断和治疗分为适当或不适当。在接受适当和不适当治疗的患者之间，比较艰难梭菌感染、急性肾损伤、90天再住院、培养后住院时间（LOS）和随后尿培养中多重耐药微生物的频率。我们纳入了166例患者的170次ASB（30%）或UTI（70%）诊断。总体而言，86.1%的患者为男性，47.6%患有SCI/D，77.6%使用膀胱导管。所有ASB患者均得到了适当的诊断，96.1%的患者得到了适当的治疗。相比之下，37例UTI（31.1%）诊断不当，61例（51.3%）治疗不当，包括30例真正的ASB。在SCI/D或MS患者中，适当的ASB或UTI诊断与较长的培养后LOS相关（中位数，14 vs 7.5天; P = 0.02）。我们没有发现适当与不适当的诊断和治疗以及其他结果之间有任何显著的联系。几乎三分之一的UTI诊断和一半的NB住院患者的治疗是不合适的。有机会改善NB患者的ASB和UTI管理，以尽量减少不适当的抗生素使用。
To compare clinical outcomes associated with appropriate and inappropriate management of asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) among inpatients with neurogenic bladder (NB). Multicenter, retrospective cohort. The study was conducted across 4 Veterans’ Affairs hospitals. The study included veterans with NB due to spinal cord injury or disorder (SCI/D), multiple sclerosis (MS), or Parkinson’s disease (PD) hospitalized between January 1, 2017, and December 31, 2018, with diagnosis of ASB or UTI. In a medical record review, we classified ASB and UTI diagnoses and treatments as appropriate or inappropriate based on national guidelines. Frequencies of Clostridioides difficile infection, acute kidney injury, 90-day hospital readmission, postculture length-of-stay (LOS), and multidrug-resistant organisms in subsequent urine cultures were compared between those who received appropriate and inappropriate management. We included 170 encounters with ASB (30%) or UTI (70%) diagnoses occurring for 166 patients. Overall, 86.1% patients were male, 47.6% had SCI/D and 77.6% used bladder catheters. All ASB encounters had appropriate diagnoses, and 96.1% had appropriate treatment. In contrast, 37 UTI encounters (31.1%) had inappropriate diagnoses and 61 (51.3%) had inappropriate treatment, including 30 encounters with true ASB. Among patients with SCI/D or MS, appropriate ASB or UTI diagnosis was associated with a longer postculture LOS (median, 14 vs 7.5 days; P = .02). We did not detect any significant associations between appropriate versus inappropriate diagnosis and treatment and other outcomes. Almost one-third of UTI diagnoses and half of treatments in hospitalized patients with NB are inappropriate. Opportunities exist to improve ASB and UTI management in patients with NB to minimize inappropriate antibiotic use.