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Antibiotics Often Overused in Asymptomatic Bacteriuria Cases
Asymptomatic bacteriuria (ABU) is often overtreated with antibiotics, especially in patients with pyuria, according to a new study.1
“Given the low incidence of infectious complications, efforts should be made to optimize the use of antibiotics in enterococcal bacteriuria,” according to the researchers from the Houston VA Research & Development Center of Excellence, the Michael E. DeBakey VA Medical Center and the Baylor College of Medicine.
A retrospective medical-record review looked at patients from two academic teaching hospitals over a three-month period during the fall of 2009. Patients were divided into two groups — those with a urinary tract infection (UTI) for whom antibiotic use was deemed appropriate, or those with asymptomatic ABU for whom antibiotic use was considered inappropriate. Appropriateness of antibiotic use was determined based on Infectious Diseases Society of America guidelines.
Medical records were reviewed for Enterococcus cultured from another sterile site within 30 days. Of 339 cases meeting inclusion criteria, 183 (54.0%) were classified as ABU and 156 (46.0%) as UTI. In 289 of those with urinalysis, pyuria was associated with UTI in 98 of 140 episodes (70.0%) compared with 63 of 149 episodes of ABU (42.3%).
Providers inappropriately treated 60 of 183 episodes of ABU (32.8%) with antibiotics, and, in multivariate analysis, only pyuria was associated with the inappropriate use of antibiotics.
The risks of withholding antibiotics turned out to be low. Only seven subsequent infections with Enterococcus occurred in the 339 episodes of bacteriuria overall (2.1%), with two of the 183 cases of ABU (1.1%) having distant infections.
1. Lin E, Bhusal Y, Horwitz D, Shelburne SA 3rd, Trautner BW. Overtreatment of enterococcal bacteriuria. Arch Intern Med. 2012 Jan 9;172(1):33-8. PubMed PMID:22232145.
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