Overtreatment of Enterococcal Bacteriuria

Lin, Eugene; Bhusal, Y.; Horwitz, Deborah; Shelburne, Samuel A.; Trautner, Barbara W.

doi:10.1001/archinternmed.2011.565

Cited by 76 publications

(64 citation statements)

References 35 publications

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“…Magliano et al collected information on bacteriuria in outpatients [9,18]. E. faecalis was found to be the most common in men and in patients aged over 60.…”

Section: Discussionmentioning

confidence: 99%

“…One of the main reasons behind this increase is thought to be the use of urinary catheters and stents, which are often associated with biofilm formation [13,21]. Givens and Wenzel showed that catheter-based UTI were responsible for prolonging hospital stays [9,22]. In the study by Croxall et al [13], patients with urinary catheters more frequently showed polymicrobial urine with E. faecalis than patients without a catheter.…”

Section: Discussionmentioning

confidence: 99%

“…Because laboratory values (urine leukocytes and E. faecalis counts) play only a limited role in urinary tract colonization and infection definitions, particularly in cases involving enterococci [9], the potential use of a urinary catheter [1,14], and associations with other more pathogenic microorganisms, our criteria in the definitions were solely clinical. The laboratory values we obtained for E. faecalis bacteriuria were not therefore used for this distinction.…”

Section: Urinary Tract Colonization and Infectionsmentioning

confidence: 99%

“…It would appear that an underlying pathological condition of the urinary tract, kidney transplant [6,7], urinary catheter [2,3] or recent use of antibiotics [8] increases the risk of enterococcal UTI or colonization. However, few studies have been published on this subject and no consensus has been reached, particularly regarding a definition of a threshold in terms of colony count [9].…”

Section: Introductionmentioning

confidence: 99%

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A comparison of monomicrobial versus polymicrobial Enterococcus faecalis bacteriuria in a French University Hospital

Fourcade

Canini

Lavigne

et al. 2015

Eur J Clin Microbiol Infect Dis

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Enterococci are of considerable relevance in the hospital setting. Their most common location is the urinary tract, where they may be responsible for both colonization and infections. They are often associated with the presence of other microorganisms. The aim was to compare monomicrobial and polymicrobial Enterococcus faecalis bacteriuria. A retrospective study was performed on the demographic, clinical, and laboratory data of 299 patients who had presented with E. faecalis bacteriuria in 2012 at a University Hospital. The bacteriuria was polymicrobial in 46.1 % of cases and in 36.4 % of cases was responsible for a urinary tract infection. Infections appeared to be more prevalent in the polymicrobial than the monomicrobial group (42 % vs 32 %, p = 0.06). Half of the patients who presented with urinary tract colonization received antibiotic treatment (54/ out of 10). A multivariate analysis adjusted for age (adjusted odds ratio [AOR] = 1.02 per year, p = 0.006), gender (AOR = 2.2, p = 0.007), and clinical classification (colonization or infection, AOR = 1.6, p = 0.091), showed that diabetes mellitus (AOR = 2.0, p = 0.04), hospital length of stay exceeding 28 days (AOR = 2.0, p = 0.03), and presence of a urinary catheter (AOR = 2.4, p = 0.001) were all factors associated with polymicrobial E. faecalis bacteriuria. A reduction in the length of hospital stay and the use of urinary catheters would appear to be required to decrease the incidence of urinary tract colonization and infections by polymicrobial E. faecalis. Improper use of antibiotics to treat urinary tract colonization remains a major concern.

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“…Magliano et al collected information on bacteriuria in outpatients [9,18]. E. faecalis was found to be the most common in men and in patients aged over 60.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Urinary Tract Colonization and Infectionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A comparison of monomicrobial versus polymicrobial Enterococcus faecalis bacteriuria in a French University Hospital

Fourcade

Canini

Lavigne

et al. 2015

Eur J Clin Microbiol Infect Dis

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“…We hypothesized, based on some preliminary data in adults, 1 that Gram-positive organisms (Staphylococcus saprophiticus and Enterococcus species) would cause less inflammation of the urinary tract and consequently cause less pyuria on urinalysis than infections caused by Gram-negative organisms (Escherichia coli, Pseudomonas aeruginosa, Klebsiella species, Proteus species, and Enterobacter species), in which pyuria is observed in the vast majority of cases. 2,3 …”

mentioning

confidence: 99%

Association Between Uropathogen and Pyuria

et al. 2016

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OBJECTIVE: We sought to determine factors associated with the absence of pyuria in symptomatic children whose urine culture was positive for a known uropathogen. METHODS:We obtained data on children evaluated at the Children's Hospital of Pittsburgh emergency department between 2007 and 2013 with symptoms of urinary tract infection (UTI) who had paired urinalysis and urine cultures. We excluded children with an unknown or bag urine collection method, major genitourinary anomalies, immunocompromising conditions, or with multiple organisms on culture. We chose a single, randomly-selected urine specimen per child and limited the analysis to those with positive cultures.RESULTS: There were 46 158 visits during the study period; 1181 children diagnosed with UTI met all inclusion criteria and had a microscopic urinalysis for pyuria. Pyuria (≥5 white blood cells per high-powered field or ≥10 white blood cells per cubic millimeter) was present in 1031 (87%) children and absent in 150 (13%). Children with Enterococcus species, Klebsiella species, and Pseudomonas aeruginosa were significantly less likely to exhibit pyuria than children with Escherichia coli (odds ratio of 0.14, 0.34, and 0.19, respectively). Children with these organisms were also less likely to have a positive leukocyte esterase on dipstick urinalysis. Results were similar when we restricted the analysis to children whose urine samples were collected by bladder catheterization. CONCLUSIONS:We found that certain uropathogens are less likely to be associated with pyuria in symptomatic children. Identification of biomarkers more accurate than pyuria or leukocyte esterase may help reduce over-and undertreatment of UTIs.

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Enhancing the Safety of Hospitalized Patients: Who Is Minding the Antimicrobials?

Flanders

Saint

2012

Arch Intern Med

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Overtreatment of Enterococcal Bacteriuria

Abstract: 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.

Cited by 76 publications

References 35 publications

A comparison of monomicrobial versus polymicrobial Enterococcus faecalis bacteriuria in a French University Hospital

A comparison of monomicrobial versus polymicrobial Enterococcus faecalis bacteriuria in a French University Hospital

Association Between Uropathogen and Pyuria

Enhancing the Safety of Hospitalized Patients: Who Is Minding the Antimicrobials?

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