An Evaluation of the Management of Asymptomatic Catheter‐Associated Bacteriuria and Candiduria at The Ottawa Hospital

Dalen, Dawn; Zvonar, Rosemary; Jessamine, Peter

doi:10.1155/2005/868179

Cited by 55 publications

(47 citation statements)

References 16 publications

(28 reference statements)

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“…[5][6][7] The findings of these studies as well as our own findings and those of Kelley et al 1 demonstrate a 32%-65% treatment rate of ASB when ASP and ASB education are lacking, despite IDSA guideline recommendations. 1,2,[5][6][7] ASPs are critically important in combating the overuse and misuse of antibiotics. We commend Kelley et al 1 for the success of their ASP educational initiative at decreasing empirical antibiotic prescribing in ASB at their institution.…”

Section: Antibiotic Burden Associated With Treatment Of Asymptomatic supporting

confidence: 66%

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Antibiotic Burden Associated with Treatment of Asymptomatic Bacteriuria

Elefritz

Deutscher

Stevenson

et al. 2014

Infect. Control Hosp. Epidemiol.

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Antibiotic Burden Associated with Treatment of Asymptomatic BacteriuriaTo the Editor-We read with interest the report by Kelley et al 1 entitled "Evaluation of an Antimicrobial Stewardship Approach to Minimize Overuse of Antibiotics in Patients with Asymptomatic Bacteriruira." These authors used an observational retrospective study design to evaluate the impact of an antimicrobial stewardship program (ASP) educational initiative on asymptomatic bacteriuria (ASB) management at their institution. Select components of the educational initiative included in-service presentations targeted at physicians and pharmacists, posting of notifications and memorandums, distribution of pocket cards, and daily review of antibiotics for the treatment of urinary tract infections (UTIs) by ASP members. They found a decrease in empirical antibiotic administration from 66 (62%) of 107 patients before the initiative to 28 (26%) of 107 patients after the initiative (P ! .0001). 1We agree with the authors that treatment of ASB presents a significant problem. The Infectious Diseases Society of America (IDSA) guidelines regarding ASB recommend against treating adults with ASB except pregnant women and individuals undergoing urologic procedures.2 Administration of antibiotics when not indicated may result in adverse drug reactions, development of antibiotic resistance, and Clostridium difficile infection.3,4 Therefore, we have also taken steps to evaluate the management of ASB at our institution and estimate the added antibiotic burden resulting from the treatment of ASB, focusing on patients with an indwelling urinary catheter. We outline the results of our evaluation here. A comparative observational study of catheterized patients with ASB was conducted. Retrospective medical record review was completed for patients who met the following inclusion criteria: (1) age 18-89 years; (2) admission to an internal medicine or surgery service between November 1, 2011, and November 31, 2012; (3) a urine culture containing 10 4 colony-forming units/mL bacteria or greater; and (4) a urinary catheter in place for 24 hours or more before the culture was obtained. Patients were excluded on the basis of documentation of 1 or more of the following symptoms of a UTI: temperature 37.9ЊC or more, costovertebral tenderness, dysuria, urinary frequency, urinary urgency, rigors, new onset delirium, and increased muscle spasticity in quadriplegic and paraplegic patients. Additional exclusion criteria similar to those used by Kelley et al 1 included pregnancy; medical history of a solid organ transplant; known urinary tract anatomical abnormality; renal stones; malignancy; foreign bodies of the urinary tract; being scheduled for genitourinary manipulation within 24 hours of culture; candiduria; death or hospital discharge before culture results were available; or current incarceration. Patients were considered to be treated for ASB if an antibiotic targeted at the bacteria isolated from the urine was administered within 5 days of culture obtainment. If a patient...

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Section: Antibiotic Burden Associated With Treatment Of Asymptomatic supporting

confidence: 66%

“…And what is considered diarrhea? 6 These ambiguities suggest that the symptom severity threshold for initiating testing could vary significantly between institutions and wards. In addition, use of more…”

mentioning

confidence: 99%

Antibiotic Burden Associated with Treatment of Asymptomatic Bacteriuria

Elefritz

Deutscher

Stevenson

et al. 2014

Infect. Control Hosp. Epidemiol.

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“…Finally, of patients with ASB who had urinary catheters, 55% (26/47 patients) were managed with catheter removal or exchange, which might have directly prevented secondary infections (24). The rates of microbiological eradication were higher among patients with catheter removal or exchange than among those with retained devices (65% versus 50%; P ϭ 0.26).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Clinical Outcomes of Patients with Carbapenem-Resistant Klebsiella pneumoniae Bacteriuria

Qureshi

Syed

Clarke

et al. 2014

Antimicrob Agents Chemother

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Carbapenem-resistant Klebsiella pneumoniae (CRKP) bacteriuria is a frequently encountered clinical condition, but its clinical impact is unknown. We conducted a retrospective cohort study to define the epidemiology and outcomes for patients with CRKP bacteriuria. Patients with positive urine cultures for CRKP were classified as having asymptomatic bacteriuria (ASB) or symptomatic urinary tract infection (UTI). Among 105 patients with CRKP bacteriuria, 80% (84/105 patients) and 20% (21/105 patients) had ASB and UTI, respectively. Older age (P ‫؍‬ 0.002) and higher Charlson's comorbidity index scores (P ‫؍‬ 0.001) were associated with ASB. The median duration of hospitalization prior to CRKP bacteriuria was significantly longer for patients with ASB versus UTI (8.5 versus 2 days; P ‫؍‬ 0.05 21 patients), including all patients who received doxycycline (n ‫؍‬ 9). The overall 30-day mortality rate was 6% (6/105 patients); the deaths were unrelated to CRKP infections. Secondary CRKP infections, including UTIs, were notably absent among patients with ASB who were followed for 90 days. In conclusion, identification of CRKP in the urine was most commonly associated with ASB and did not lead to subsequent infections or death among asymptomatic patients. Factors associated with UTIs included male sex, solid-organ transplantation, and neurogenic bladder. Doxycycline may be an effective therapy for CRKP UTIs.

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“…Old age, long stayin hospital, using broad spectrum antibiotics, and renal defects are the most important predisposing factors for candiduria (1,5,7,8). Several reports have indicated that candiduria is a very common infection in hospitalized patients and its incidence is linked to antibiotic usage, long stay in hospitals, old age etc (2,6,9).…”

Section: Introductionmentioning

confidence: 99%

Antifungal susceptibility of Candida species isolated from candidura

Mahmoudabadi

Zarrin

Fard

2012

Jundishapur J Microbiol

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Candiduria is a common infection of the urinary tract. Evaluation of the susceptibility to antifungal drugs could be used for treatment and control of infection.Background: Candiduria is one of the most common symptoms of urinary tract infections caused by several species of Candida spp.. Several antifungals are available to treat such candidal infections. During the last decades, resistance to antifungal especially to non-albicans species has increased. Objectives: The present study aimed to evaluate the susceptibility to antifungal drugs of Candida species isolated from candiduria in Ahvaz. Materials and Methods: Ninety three species of yeasts and yeast like organisms isolated from urine samples [Candida albicans (58), C. glabrata (25), C. tropicalis (4), C. krusei (1), unknown Candida species (4) and Geotrichum species (1)] were used for susceptibility tests. All species were re-identified based on standard mycological methods. Then a suspension of each isolate of overnight cultures was prepared in 1ml of sterile PBS and adjusted to 0.5 McFarland turbidity standards. In the present study several antifungal drugs (fluconazole, amphotericine B, ketoconazole, econazole, itraconazole) were used for susceptibility test using disk diffusion method. Results:In the present study all tested isolates were sensitive/dose dependent to amphotericine B and nystatin, whereas only one isolate of C. glabrata was resistant to both antifungals. Resistance against fluconazole (48.4%) and ketoconazole (26.9%) were observed among tested isolates. Resistance against fluconazole was detected among all tested organisms, 34.4% of C. albicans, and 7.5% of C. glabrata. On the other hand, all isolates were sensitive to econazole (93.5% sensitive, 6.5% dose dependent). Conclusions: It was concluded that Candida species isolated from candiduria in hospitalized patients had excellent in vitro sensitivity against econazole. Other suitable antifungal drugs were amphotericine B and nystatin, itraconazole. Whereas, resistance against ketoconazole (26.9%) and especially fluconazole (48.4%) was significant.

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An Evaluation of the Management of Asymptomatic Catheter‐Associated Bacteriuria and Candiduria at The Ottawa Hospital

Abstract: Antimicrobial agents were prescribed in over one-half of CAUTI cases, contrary to recommendations from the literature. Education is required to bring this strongly supported recommendation into clinical practice.

Cited by 55 publications

References 16 publications

Antibiotic Burden Associated with Treatment of Asymptomatic Bacteriuria

Antibiotic Burden Associated with Treatment of Asymptomatic Bacteriuria

Epidemiology and Clinical Outcomes of Patients with Carbapenem-Resistant Klebsiella pneumoniae Bacteriuria

Antifungal susceptibility of Candida species isolated from candidura

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