Fitzpatrick Margaret A, Wirth Marissa, Nguyen Jimmy, Suda Katie J, Weaver Frances M, Burns Stephen, Collins Eileen, Safdar Nasia, Patel Ursula, Evans Charlesnika T
Rocky Mountain Regional VA Medical Center, Aurora, Colorado.
University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Antimicrob Steward Healthc Epidemiol. 2022 Dec 9;2(1):e195. doi: 10.1017/ash.2022.348. eCollection 2022.
To compare clinical outcomes associated with appropriate and inappropriate management of asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) among inpatients with neurogenic bladder (NB).
Multicenter, retrospective cohort.
The study was conducted across 4 Veterans' Affairs hospitals.
The study included veterans with NB due to spinal cord injury or disorder (SCI/D), multiple sclerosis (MS), or Parkinson's disease (PD) hospitalized between January 1, 2017, and December 31, 2018, with diagnosis of ASB or UTI.
In a medical record review, we classified ASB and UTI diagnoses and treatments as appropriate or inappropriate based on national guidelines.
Frequencies of infection, acute kidney injury, 90-day hospital readmission, postculture length-of-stay (LOS), and multidrug-resistant organisms in subsequent urine cultures were compared between those who received appropriate and inappropriate management.
We included 170 encounters with ASB (30%) or UTI (70%) diagnoses occurring for 166 patients. Overall, 86.1% patients were male, 47.6% had SCI/D and 77.6% used bladder catheters. All ASB encounters had appropriate diagnoses, and 96.1% had appropriate treatment. In contrast, 37 UTI encounters (31.1%) had inappropriate diagnoses and 61 (51.3%) had inappropriate treatment, including 30 encounters with true ASB. Among patients with SCI/D or MS, appropriate ASB or UTI diagnosis was associated with a longer postculture LOS (median, 14 vs 7.5 days; = .02). We did not detect any significant associations between appropriate versus inappropriate diagnosis and treatment and other outcomes.
Almost one-third of UTI diagnoses and half of treatments in hospitalized patients with NB are inappropriate. Opportunities exist to improve ASB and UTI management in patients with NB to minimize inappropriate antibiotic use.
比较神经源性膀胱（NB）住院患者无症状菌尿（ASB）和尿路感染（UTI）的恰当与不恰当管理所带来的临床结局。
多中心回顾性队列研究。
该研究在4家退伍军人事务医院开展。
研究纳入了2017年1月1日至2018年12月31日期间因脊髓损伤或疾病（SCI/D）、多发性硬化（MS）或帕金森病（PD）而患有NB并诊断为ASB或UTI的退伍军人。
在病历审查中，我们根据国家指南将ASB和UTI的诊断与治疗分类为恰当或不恰当。
比较接受恰当与不恰当管理的患者之间的感染频率、急性肾损伤、90天内再次入院、培养后住院时间（LOS）以及后续尿培养中多重耐药菌的情况。
我们纳入了166例患者发生的170次ASB（30%）或UTI（70%）诊断。总体而言，86.1%的患者为男性，47.6%患有SCI/D，77.6%使用膀胱导管。所有ASB诊断均恰当，96.1%的治疗恰当。相比之下，37次UTI诊断（31.1%）不恰当，61次（51.3%）治疗不恰当，其中包括30次实际为ASB的情况。在患有SCI/D或MS的患者中，恰当的ASB或UTI诊断与培养后更长的住院时间相关（中位数，14天对7.5天；P = 0.02）。我们未发现恰当与不恰当诊断及治疗与其他结局之间存在任何显著关联。
NB住院患者中近三分之一的UTI诊断和一半的治疗不恰当。存在改善NB患者ASB和UTI管理以尽量减少不恰当抗生素使用的机会。
