Memorial University of Newfoundland Department of Clinical Epidemiology, St John's, Newfoundland and Labrador, Canada.
Memorial University of Newfoundland, Faculty of Medicine, St John's, Newfoundland and Labrador, Canada.
Infect Control Hosp Epidemiol. 2021 Oct;42(10):1221-1227. doi: 10.1017/ice.2020.1397. Epub 2021 Jun 4.
To determine whether modified reporting of positive urine cultures collected from indwelling catheters improved treatment decisions without causing harm.
Prospective, unblinded, randomized control trial.
Two tertiary-care hospitals.
Overall, 100 consecutive positive urine cultures collected from catheterized inpatients were randomized between standard and modified laboratory reporting between November 2018 and June 2019. Exclusion criteria were pregnancy, current antibiotic treatment, ICU or urology admission, or neutropenia.
The modified report included significant growth without providing identification, quantification, or susceptibility. The standard report included identification, quantitation and susceptibility. Diagnosis of catheter-associated asymptomatic bacteriuria (CA-ASB) and catheter-associated urinary tract infection (CA-UTI) followed published criteria, using prospective chart review. The appropriate antibiotic treatment was defined as treatment of CA-UTI, and no treatment of CA-ASB. Patients were followed for 7 days.
Of 543 urine cultures, 443 (82%) were excluded. Of 100 patients, 75 (75%) had CA-ASB and 25 (25%) had CA-UTI. Treatment was given to 45 of 75 CA-ASB patients (60%) and all 25 CA-UTI patients (100%). Appropriate treatment rate was higher in the modified reporting arm than in the standard reporting arm: 57% vs 50% (+7.4%; relative risk [RR], 1.15; P = .45). Untreated CA-ASB was higher in the modified reporting arm: 45% vs 33% (+12%; RR, 1.36; P = .30). The standard report was requested for 33% of modified reports. Furthermore, 4 deaths and 26.9% adverse events occurred in the modified reporting arm, and 3 deaths and 41.3% adverse events occurred in the standard reporting arm.
Modified reporting increased the appropriateness of treatment, and may be safe.Clinical trials identifier: ClinicalTrials.gov#NCT03488355.
确定改良报告留置导尿管采集的阳性尿液培养结果是否可以在不造成伤害的情况下改善治疗决策。
前瞻性、非盲、随机对照试验。
两家三级保健医院。
2018 年 11 月至 2019 年 6 月，连续对 100 例留置导尿管住院患者的阳性尿液培养进行了前瞻性随机分组，分为标准报告组和改良报告组。排除标准为妊娠、当前抗生素治疗、入住 ICU 或泌尿科或中性粒细胞减少症。
改良报告包括显著生长，但不提供鉴定、定量或药敏结果。标准报告包括鉴定、定量和药敏。根据前瞻性图表审查，采用已发表的标准诊断导管相关性无症状菌尿（CA-ASB）和导管相关性尿路感染（CA-UTI）。适当的抗生素治疗定义为治疗 CA-UTI，而不治疗 CA-ASB。患者随访 7 天。
在 543 份尿液培养物中，有 443 份（82%）被排除。在 100 例患者中，75 例（75%）患有 CA-ASB，25 例（25%）患有 CA-UTI。45 例 CA-ASB 患者（60%）和 25 例 CA-UTI 患者（100%）接受了治疗。改良报告组的适当治疗率高于标准报告组：57%比 50%（+7.4%；相对风险 [RR]，1.15；P=.45）。改良报告组未治疗的 CA-ASB 更高：45%比 33%（+12%；RR，1.36；P=.30）。改良报告中有 33%要求提供标准报告。此外，改良报告组有 4 例死亡和 26.9%的不良事件，标准报告组有 3 例死亡和 41.3%的不良事件。
改良报告提高了治疗的适当性，并且可能是安全的。
ClinicalTrials.gov#NCT03488355。
