Inappropriate Treatment of Catheter-Associated Asymptomatic Bacteriuria in a Tertiary Care Hospital
Inappropriate Treatment of Catheter-Associated Asymptomatic Bacteriuria in a Tertiary Care Hospital
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DOI：
10.1086/597403
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发表时间：
2009-05-01
影响因子：
11.8
通讯作者：
Trautner, Barbara W.
中科院分区：
文献类型：
--
作者：
Cope, Matthew;Cevallos, Manuel E.;Trautner, Barbara W.
背景循证指南指出，无症状菌尿在男性和非妊娠女性中不是一种具有临床意义的疾病，治疗不太可能带来临床获益。我们假设，在使用留置导管或避孕套收集系统的患者中，许多接受导管相关尿路感染（CAUTI）诊断和治疗的患者实际上患有无症状菌尿，因此抗生素治疗是不合适的。方法。我们回顾了退伍军人事务医疗中心3个月内的所有尿培养结果。如果使用留置（Foley）导尿管或避孕套收集系统从住院患者中采集尿液，则包括产生>= 10（4）菌落形成单位/mL的培养物。我们应用标准化的定义来确定该事件是否代表导管相关性无症状菌尿（CAABU）或尿路感染。抗生素治疗被认为是适当的患者谁符合症状性尿路感染的标准。总体而言，280例发作符合入选标准：164例CAABU和116例CANTI。在164例CAABU中，111例（68%）得到了适当的治疗（未治疗），而53例（32%）接受了抗生素治疗（治疗不当）。在多变量分析中，年龄较大、以革兰阴性菌尿为主、尿白色细胞计数较高的患者与CAABU治疗不当显著相关（P
Background. Evidence-based guidelines state that asymptomatic bacteriuria is not a clinically significant condition in men and nonpregnant women and that treatment is unlikely to confer clinical benefit. We hypothesized that, among patients with indwelling catheters or condom collection systems, many who receive a diagnosis of and are treated for catheter-associated urinary tract infection (CAUTI) actually have asymptomatic bacteriuria and, therefore, that antibiotic therapy is inappropriate.Methods. We reviewed all urine culture results at a veterans affairs medical center during a 3-month period. Cultures yielding >= 10(4) colony-forming units/mL were included if the urine had been collected from a hospitalized patient with an indwelling (Foley) catheter or a condom collection system. We applied standardized definitions to determine whether the episode represented catheter-associated asymptomatic bacteriuria (CAABU) or CAUTI. Antibiotic therapy was considered appropriate for patients who met criteria for symptomatic UTI.Results. Overall, 280 episodes met criteria for inclusion: 164 CAABU and 116 CAUTI. Of the 164 episodes of CAABU, 111 (68%) were managed appropriately (no treatment), whereas 53 (32%) were treated with antibiotics (inappropriate treatment). In multivariate analysis, older patient age, having predominantly gram-negative bacteriuria, and higher urine white blood cell count were significantly associated with inappropriate treatment of CAABU (P