Overtreatment of Enterococcal Bacteriuria
Overtreatment of Enterococcal Bacteriuria
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DOI：
10.1001/archinternmed.2011.565
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发表时间：
2012-01-09
影响因子：
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通讯作者：
Trautner, Barbara W.
中科院分区：
文献类型：
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作者：
Lin, Eugene;Bhusal, Yogesh;Trautner, Barbara W.
背景资料：本研究的目的是调查肠球菌菌尿症的临床结局，并确定目前的管理是否符合美国传染病学会guidelines.Methods：我们进行了3个月（2009年9月1日至11月30日）的2个学术教学医院的患者的回顾性病历审查。根据指南将患者分为尿路感染（UTI）或无症状菌尿（ABU）。抗生素的使用被认为是适当的UTI患者和ABU不适当。病历审查肠球菌培养从另一个无菌sites.Results：共375尿培养肠球菌进行了审查，与339文化符合纳入标准。在这339次发作中，183次（54.0%）被归类为ABU，156次（46.0%）被归类为UTI。在289次伴有尿分析的发作中，140次发作中有98次（70.0%）脓尿与UTI相关，而149次发作中有63次（42.3%）ABU相关（比值比，3.19; 95%CI，1.96-5.18）。183例ABU中有60例（32.8%）使用抗生素治疗不当。在多变量分析中，只有脓尿与抗生素使用不当有关（比值比，3.27; 95%CI，1.49-7.18）。只有7随后感染肠球菌发生在339例菌尿的整体（2.1%），与2的183例ABU（1.1%）有远处infection.Conclusions：供应商往往过度治疗肠球菌ABU抗生素，特别是在脓尿患者。鉴于感染性并发症的发生率低，应努力优化抗生素在肠球菌菌尿症中的使用。
Background: The purposes of this study were to investigate the clinical outcomes of enterococcal bacteriuria and to determine whether current management is adherent to Infectious Diseases Society of America guidelines.Methods: We conducted a retrospective medical record review of patients from 2 academic teaching hospitals for 3 months (September 1 through November 30, 2009). Patients were classified as having urinary tract infection (UTI) or asymptomatic bacteriuria (ABU) by applying the guidelines. Antibiotic use was deemed appropriate in patients with UTI and inappropriate in ABU. Medical records were reviewed for Enterococcus cultured from another sterile site within 30 days.Results: A total of 375 urine cultures growing Enterococcus were reviewed, with 339 cultures meeting inclusion criteria. Of these 339 episodes, 183 (54.0%) were classified as ABU and 156 (46.0%) as UTI. In 289 episodes accompanied by urinalysis, pyuria was associated with UTI in 98 of 140 episodes (70.0%) compared with 63 of 149 episodes of ABU (42.3%) (odds ratio, 3.19; 95% CI, 1.96-5.18). Providers inappropriately treated 60 of 183 episodes of ABU (32.8%) with antibiotics. In multivariate analysis, only pyuria was associated with the inappropriate use of antibiotics (odds ratio, 3.27; 95% CI, 1.49-7.18). Only 7 subsequent infections with Enterococcus occurred in the 339 episodes of bacteriuria overall (2.1%), with 2 of the 183 cases of ABU (1.1%) having distant infection.Conclusions: Providers often overtreat enterococcal ABU with antibiotics, particularly in patients with pyuria. Given the low incidence of infectious complications, efforts should be made to optimize the use of antibiotics in enterococcal bacteriuria.