Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of Americaa

Nicolle, Lindsay E.; Gupta, Kalpana; Bradley, Suzanne F.; Colgan, Richard; DeMuri, Gregory P.; Drekonja, Dimitri; Eckert, Linda O.; Geerlings, Suzanne E.; Köves, Béla; Hooton, Thomas M.; Juthani‐Mehta, Manisha; Knight, Shandra L; Saint, Sanjay; Schaeffer, Anthony J.; Trautner, Barbara W.; Wullt, Björn; Siemieniuk, Reed A C

doi:10.1093/cid/ciy1121

Cited by 299 publications

(373 citation statements)

References 180 publications

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“…Despite national guidelines that clearly limit the indications for treatment of ASB (eg, pregnancy and impending invasive urologic procedure), antibiotics are often inappropriately prescribed . Distinguishing true infection from ASB is challenging, but, as this study supports, appropriate diagnosis can be guided by comprehensive educational interventions designed for LTC facilities.…”

Section: Discussionmentioning

confidence: 81%

“…Suspected urinary tract infections (UTIs) are the most common indication for antibiotic use in LTC; however, overdiagnosis and overtreatment of UTIs are widespread due to the high prevalence of asymptomatic bacteriuria (ASB), for which antibiotics are not warranted . ASB is a laboratory finding of a positive urine culture in the absence of symptoms consistent with a UTI . Randomized and population‐based studies reveal no decrease in rate of symptoms or improvement in survival with treatment of ASB in older individuals .…”

mentioning

confidence: 99%

“…Randomized and population‐based studies reveal no decrease in rate of symptoms or improvement in survival with treatment of ASB in older individuals . Current guidelines recommend against routine screening for and treatment of ASB in older individuals in LTC, as well as in most other clinical situations.…”

mentioning

confidence: 99%

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A Statewide Program to Improve Management of Suspected Urinary Tract Infection in Long‐Term Care

Salem‐Schatz¹,

Griswold²,

Kandel

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Suspected urinary tract infection (UTI) is the most common indication for antibiotic use in long‐term care (LTC). Due to the high prevalence of asymptomatic bacteriuria, for which antibiotics are not warranted, these antibiotics are frequently unnecessary. We implemented a collaborative quality improvement program to improve the management of suspected UTI in LTC residents by increasing awareness of current guidelines, with a focus on decreasing treatment in the absence of symptoms. DESIGN/INTERVENTION Two separate collaboratives included workshops, webinars, and coaching calls. PARTICIPANTS A total of 31 facilities participated in the first collaborative, with 17 submitting sufficient data for analysis and 34 in the second, with data analyzed from 25. MEASUREMENTS Facilities reported monthly numbers of urine cultures, UTI diagnoses, Clostridioides difficile infections (CDIs), and resident days. RESULTS When comparing the baseline period to the first collaborative period, the intercollaborative period to the second collaborative period, and the first collaborative period to the second, the incident rate ratios (95% confidence intervals) were 0.74 (0.68‐0.81), 0.83 (0.73‐0.94), and 0.63 (0.57‐0.69), respectively, for urine culturing rate; 0.73 (0.64‐0.83), 0.86 (0.70‐1.05), and 0.60 (0.51‐0.69), respectively, for UTI diagnosis rate; and 0.56 (0.40‐0.82), 1.61 (0.71‐4.14), and 0.45 (0.27‐0.74), respectively, for CDI rate. CONCLUSION The program we implemented was associated with reductions in urine cultures, UTI diagnosis, and CDI; and it suggests that this type of intervention can promote appropriate management of UTI in the LTC setting. J Am Geriatr Soc 68:62–69, 2019

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Section: Discussionmentioning

confidence: 81%

mentioning

confidence: 99%

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A Statewide Program to Improve Management of Suspected Urinary Tract Infection in Long‐Term Care

Salem‐Schatz¹,

Griswold²,

Kandel

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…UTI is defined as the presence of both urinary tract symptoms (e.g. suprapubic tenderness, costovertebral angle pain or tenderness, urinary urgency or frequency or dysuria) and isolation of a urinary pathogen at ≥10 5 colony forming units/mL in a freshly voided mid‐stream urine specimen . Some definitions also include reference to one of the following additional criteria: no more than two species of organisms identified on urine culture; pyuria (>10 white blood cells/mm 3 per high‐power field); growth of only ≥10 3 colony forming units/mL of a urinary pathogen on urine culture, in those with a catheter‐acquired UTI. …”

Section: Definitionsmentioning

confidence: 99%

“…ASB is defined as ≥10 5 colony forming units/mL in a correctly collected urine specimen from an individual with no typical symptoms or signs of urinary system disease . ASB is associated with pyuria to no less an extent than in UTI .…”

Section: Definitionsmentioning

confidence: 99%