Prospective Randomized Comparison of Therapy and No Therapy for Asymptomatic Bacteriuria in Institutionalized Elderly Women

Nicolle, Lindsay E.; Mayhew, W.J.; Bryan, L. E.

doi:10.1016/s0022-5347(17)42454-2

Cited by 75 publications

(135 citation statements)

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“…Prospective, randomized trials of treatment or no treatment of asymptomatic bacteriuria consistently conclude that antimicrobial therapy for asymptomatic bacteriuria is not beneficial in most populations (Table 5) (37)(38)(39)(40)(41)(42)(43)(44). Clinical trials have documented no benefit for the treatment of asymptomatic bacteriuria in subjects with chronic indwelling catheters (42), elderly men or women residing in nursing homes (17,(37)(38)(39), patients with spinal cord injury managed with intermittent catheterization (41) and women with diabetes (44).…”

Section: Antimicrobial Therapy Asymptomatic Urinary Infectionmentioning

confidence: 99%

“…Clinical trials have documented no benefit for the treatment of asymptomatic bacteriuria in subjects with chronic indwelling catheters (42), elderly men or women residing in nursing homes (17,(37)(38)(39), patients with spinal cord injury managed with intermittent catheterization (41) and women with diabetes (44). These studies also document harmful outcomes with antimicrobial therapy, including adverse drug effects and reinfection with more resistant organisms.…”

Section: Antimicrobial Therapy Asymptomatic Urinary Infectionmentioning

confidence: 99%

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Complicated Urinary Tract Infection in Adults

Nicolle¹

2005

Canadian Journal of Infectious Diseases and Medical Microbiolog

216

156

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OBJECTIVE: To review current knowledge relevant to complicated urinary tract infection, and to provide evidence-based recommendations for management. METHODS: The literature was reviewed through a PubMed search, and additional articles were identified by journal reference review. A draft guideline was prepared and critically reviewed by members of the Association of Medical Microbiology and Infectious Disease Canada Guidelines Committee, with modifications incorporated following the review. RESULTS: Many urological abnormalities may be associated with complicated urinary infection. There is a wide spectrum of potential infecting organisms, and isolated bacteria tend to be more resistant to antimicrobial therapy. Morbidity and infection outcomes in subjects with complicated urinary infection are principally determined by the underlying abnormality rather than the infection. Principles of management include uniform collection of a urine specimen for culture before antimicrobial therapy, characterization of the underlying genitourinary abnormality, and nontreatment of asymptomatic bacteriuria except before an invasive genitourinary procedure. The antimicrobial regimen is determined by clinical presentation, patient tolerance, renal function and known or anticipated infecting organisms. If the underlying abnormality contributing to the urinary infection cannot be corrected, then early post-treatment recurrence of infection is anticipated. CONCLUSIONS: The management of complicated urinary infection is individualized depending on patient variables and the infecting organism. Further clinical investigations are necessary to assist in determining optimal antimicrobial regimens.

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Section: Antimicrobial Therapy Asymptomatic Urinary Infectionmentioning

confidence: 99%

Section: Antimicrobial Therapy Asymptomatic Urinary Infectionmentioning

confidence: 99%

Complicated Urinary Tract Infection in Adults

Nicolle¹

2005

Canadian Journal of Infectious Diseases and Medical Microbiolog

216

156

View full text Add to dashboard Cite

show abstract

“…10 Prospective studies have also shown an increase in adverse drug effects and the isolation of increasingly resistant bacteria among patients who received antimicrobial therapy for asymptomatic bacteriuria compared with those who did not. 8 In a recent randomized prospective trial involving 673 young women with asymptomatic bacteriuria, the occurrence of symptomatic urinary tract infection in the subsequent year was significantly higher among those who received treatment for asymptomatic bacteriuria than among those who did not (48.6% v. 13%, p < 0.001). 9 This study supports the theory that antimicrobial therapy for asymptomatic bacteriuria increases a patient's susceptibility to urinary tract infection by altering the normal intestinal and vaginal flora, which can lead to overgrowth of other uropathogens.…”

Section: Decisionsmentioning

confidence: 98%

“…Five prospective randomized controlled trials have not shown any benefit in treating asymptomatic bacteriuria. 1,8,9 Despite these findings, about half of patients with asymptomatic bacteriuria are prescribed antimicrobial therapy, which may result in unintended negative consequences.…”

Section: Decisionsmentioning

confidence: 99%