Inappropriate Treatment of Catheter‐Associated Asymptomatic Bacteriuria in a Tertiary Care Hospital

Cope, Matthew; Cevallos, Manuel; Cadle, Richard M.; Darouiche, Rabih O.; Musher, Daniel M.; Trautner, Barbara W.

doi:10.1086/597403

Cited by 158 publications

(117 citation 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: 65%

“…The National Healthcare Safety Network surveillance definitions attempt to standardize testing rates. 5 Specifically, all unformed stool specimens that are sent to the hospital laboratory are subjected to CDI testing, and repeat specimens obtained within 2 weeks are considered to be duplicates and not reported, but these measures do not specify who should or should not undergo testing. Are samples from all patients with diarrhea tested, or only a portion?…”

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confidence: 99%

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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: 65%

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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“…Various studies show that it's not always possible to establish a connection between Bacteruria and symptomatic urinary tract infection.Urine cultures are sometimes taken in patients presenting with fever or confusion suspected for infectious origin. However, positive results do not necessarily indicate a urinary tract infection or an infection at all (Cope et al, 2009). Therefore, Bacteruria in the hospitalized patient is not an indication to begin antibiotic therapy, in patients with or without a catheter (Silver et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

The ÂNEW SETTLERSâ: RESULTS OF a BACTERIOLOGICAL SURVEY DURING THE FIRST 6-Months OPERATION PERIOD OF AN INTERNAL MEDICINE WARD IN a TERTIARY HOSPITAL

Segal¹

2013

American Journal of Infectious Diseases

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During the first six months of operating a new Internal-medicine ward in a tertiary hospital, a prospective survey, tracking both patient and environment bacteriological samples taken, was conducted. The motive behind the study was to establish the pattern in which environmental colonization is transmitted to the hospitalized patients and vice versa, thus defining the nosocomial pathogens that are typical to the ward. That information can be used to guide empirical antibiotic treatment. Patient sampling was done on clinical grounds whereas environmental cultures were systematically acquired from different surfaces around the ward. 6-months' results analysis suggest that clinically guided culture rates were tightly associated with volume of patients admitted, with no such association demonstrated between volume of cultures taken and rate of positive results, except for urine cultures. Regarding environmental sampling, we demonstrated no benefit in taking empirical, surface samples for common nosocomial pathogens. Our findings could further improve future resources allocation with regard to infection control and clinical bacteriology routines in newly established internal medicine wards.

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“…Recent studies have highlighted that in contrast to catheter-associated UTI (CAUTI) caused by other bacteria, MRSA dissemination to bacteremia following bacteriuria occurs more frequently (5 vs. 20%, respectively) and manifests rapidly, typically within 2 d of a urine positive culture (4,12,22). Overall, CAUTI is the leading cause of secondary hospital-associated bloodstream infections (BSIs) (23), and MRSA BSIs are associated with high rates of morbidity and mortality, frequently resulting in metastatic infections of other organs and tissues, endocarditis, and septic shock (4,8,12,18,24,25).…”

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confidence: 99%

Catheterization alters bladder ecology to potentiate Staphylococcus aureus infection of the urinary tract

Walker

Flores-Mireles

Pinkner

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

103

164

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Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of catheter-associated urinary tract infection (CAUTI), which frequently progresses to more serious invasive infections. We adapted a mouse model of CAUTI to investigate how catheterization increases an individual's susceptibility to MRSA UTI. This analysis revealed that catheterization was required for MRSA to achieve high-level, persistent infection in the bladder. As shown previously, catheter placement induced an inflammatory response resulting in the release of the host protein fibrinogen (Fg), which coated the bladder and implant. Following infection, we showed that MRSA attached to the urothelium and implant in patterns that colocalized with deposited Fg. Furthermore, MRSA exacerbated the host inflammatory response to stimulate the additional release and accumulation of Fg in the urinary tract, which facilitated MRSA colonization. Consistent with this model, analysis of catheters from patients with S. aureus-positive cultures revealed colocalization of Fg, which was deposited on the catheter, with S. aureus. Clumping Factors A and B (ClfA and ClfB) have been shown to contribute to MRSA-Fg interactions in other models of disease. We found that mutants in clfA had significantly greater Fg-binding defects than mutants in clfB in several in vitro assays. Paradoxically, only the ClfB − strain was significantly attenuated in the CAUTI model. Together, these data suggest that catheterization alters the urinary tract environment to promote MRSA CAUTI pathogenesis by inducing the release of Fg, which the pathogen enhances to persist in the urinary tract despite the host's robust immune response.host-pathogen interactions | MRSA CAUTI | ClfB-fibrinogen interactions

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Inappropriate Treatment of Catheter‐Associated Asymptomatic Bacteriuria in a Tertiary Care Hospital

Abstract: Better recognition of CAABU and the distinction between this condition and CAUTI, consistent with evidence-based guidelines, may play a key role in reducing unneeded antibiotic usage in hospitalized patients.

Cited by 158 publications

References 25 publications

Antibiotic Burden Associated with Treatment of Asymptomatic Bacteriuria

Antibiotic Burden Associated with Treatment of Asymptomatic Bacteriuria

The ÂNEW SETTLERSâ: RESULTS OF a BACTERIOLOGICAL SURVEY DURING THE FIRST 6-Months OPERATION PERIOD OF AN INTERNAL MEDICINE WARD IN a TERTIARY HOSPITAL

Catheterization alters bladder ecology to potentiate Staphylococcus aureus infection of the urinary tract

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Inappropriate Treatment of Catheter‐Associated Asymptomatic Bacteriuria in a Tertiary Care Hospital

Abstract: Better recognition of CAABU and the distinction between this condition and CAUTI, consistent with evidence-based guidelines, may play a key role in reducing unneeded antibiotic usage in hospitalized patients.

Cited by 158 publications

References 25 publications

Antibiotic Burden Associated with Treatment of Asymptomatic Bacteriuria

Antibiotic Burden Associated with Treatment of Asymptomatic Bacteriuria

The ÂNEW SETTLERSâ: RESULTS OF a BACTERIOLOGICAL SURVEY DURING THE FIRST 6-Months OPERATION PERIOD OF AN INTERNAL MEDICINE WARD IN a TERTIARY HOSPITAL

Catheterization alters bladder ecology to potentiate Staphylococcus aureus infection of the urinary tract

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The ÂNEW SETTLERSâ: RESULTS OF a BACTERIOLOGICAL SURVEY DURING THE FIRST 6-Months OPERATION PERIOD OF AN INTERNAL MEDICINE WARD IN a TERTIARY HOSPITAL