Laguë Antoine, Boucher Valérie, Joo Pil, Yadav Krishan, Morasse Charles, Émond Marcel
Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec - Université Laval, 1401, 18ièmerue, Québec, QC, G1J 1Z4, Canada.
VITAM - Centre de Recherche en Santé Durable, Québec, QC, Canada.
CJEM. 2022 Jan;24(1):61-67. doi: 10.1007/s43678-021-00148-1. Epub 2021 Jun 28.
Current guidelines suggest assessing non-infectious causes and careful observation before giving antibiotics to delirious patients with asymptomatic bacteriuria. Our study aims to describe the current practice of Canadian physicians regarding the investigation and treatment of asymptomatic bacteriuria in delirious older patients (aged ≥ 65 years).
Our team of medical experts designed and reviewed a cross-sectional online survey. Study participants were physicians who conduct their clinical practice in Canada and care for older patients with delirium in their current practice. Potential study participants were reached through Canadian associations: Canadian Geriatrics Society, the Canadian Association of Emergency Physicians, the Association des Médecins d'Urgence du Québec and members of Choosing Wisely Canada.
297 physicians were included. The main results show 79.4% of our participants request a urine dipstick or urinalysis in delirious patients and 52.4% immediately order a urine culture with the urinalysis. If bacteriuria is found in delirious but afebrile patients without urinary symptoms, 38% of physicians immediately treat with antibiotics, 33.8% wait for culture before initiating treatment, 14.4% treat if no other cause is found for delirium and only 13.7% would refrain from giving antibiotics. Results from respondents were similar for delirious patients with known cognitive impairment. Participants were almost unanimous (92.5%) in saying they need clear guidelines regarding the treatment of bacteriuria in older delirious patients.
This survey highlights the heterogeneous clinical management of asymptomatic bacteriuria in delirious patients and the need for clear guidelines for patients.
当前指南建议，在给无症状菌尿的谵妄患者使用抗生素之前，先评估非感染性病因并进行仔细观察。我们的研究旨在描述加拿大医生对老年谵妄患者（年龄≥65岁）无症状菌尿的调查和治疗的当前做法。
我们的医学专家团队设计并审查了一项横断面在线调查。研究参与者是在加拿大从事临床实践且目前在照顾老年谵妄患者的医生。通过加拿大的一些协会联系潜在的研究参与者：加拿大老年医学会、加拿大急诊医师协会、魁北克急诊医师协会以及明智选择加拿大组织的成员。
纳入了297名医生。主要结果显示，79.4%的参与者会对谵妄患者进行尿试纸检测或尿液分析，52.4%会在进行尿液分析时立即开出尿培养检查单。如果在没有泌尿系统症状的谵妄但无发热的患者中发现菌尿，38%的医生会立即使用抗生素治疗，33.8%会等待培养结果出来后再开始治疗，14.4%会在未发现其他谵妄病因时进行治疗，只有13.7%会避免使用抗生素。对于已知有认知障碍的谵妄患者，受访者的结果类似。几乎所有参与者（92.5%）表示他们需要关于老年谵妄患者菌尿治疗的明确指南。
这项调查突出了谵妄患者无症状菌尿的临床管理存在异质性，以及为患者制定明确指南的必要性。
