Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, IL; Loyola University Chicago Stritch School of Medicine, Maywood, IL.
Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, IL.
Arch Phys Med Rehabil. 2024 Jan;105(1):112-119. doi: 10.1016/j.apmr.2023.09.023. Epub 2023 Oct 10.
Inappropriate diagnosis and treatment of asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) are leading causes of antibiotic overuse but have not been well-studied in patients with risks for complicated UTI such as neurogenic bladder (NB). Our aim was to describe ASB and UTI management in patients with NB and assess factors associated with inappropriate management.
Retrospective cohort study.
Four Department of Veteran's Affairs (VA) medical centers.
Adults with NB due to spinal cord injury/disorder (SCI/D), multiple sclerosis (MS), or Parkinson disease (PD) and encounters with an ASB or UTI diagnosis between 2017 and 2018. Clinical and encounter data were extracted from the VA Corporate Data Warehouse and medical record reviews for a stratified sample of 300 encounters from N=291 patients.
None.
Prevalence of appropriate and inappropriate ASB and UTI diagnosis and treatment was summarized. Multivariable logistic regression models assessed factors associated with inappropriate management.
N=200 UTI and N=100 ASB encounters were included for the 291 unique patients (SCI/D, 39.9%; MS, 36.4%; PD, 23.7%). Most patients were men (83.3%), >65 years (62%), and used indwelling or intermittent catheterization (68.3%). Nearly all ASB encounters had appropriate diagnosis (98%). 70 (35%) UTI encounters had inappropriate diagnosis, including 55 (27.5%) with true ASB, all with inappropriate treatment. Among the remaining 145 UTI encounters, 54 (27%) had inappropriate treatment. Peripheral vascular disease, chronic kidney disease, and cerebrovascular disease were associated with increased odds of inappropriate management; indwelling catheter (aOR 0.35, P=.01) and Physical Medicine & Rehabilitation provider (aOR 0.29, P<.01) were associated with decreased odds.
Up to half of UTI encounters for patients with NB had inappropriate management, largely due to inappropriate UTI diagnosis in patients with true ASB. Interventions to improve ASB and UTI management in patients with NB should target complex patients with comorbidities being seen by non-rehabilitation providers.
无症状性菌尿（ASB）和尿路感染（UTI）的不恰当诊断和治疗是抗生素过度使用的主要原因，但在神经源性膀胱（NB）等易发生复杂性 UTI 的患者中，这方面的研究并不充分。我们的目的是描述 NB 患者的 ASB 和 UTI 管理情况，并评估与不恰当管理相关的因素。
回顾性队列研究。
四家退伍军人事务部（VA）医疗中心。
因脊髓损伤/疾病（SCI/D）、多发性硬化症（MS）或帕金森病（PD）而患有 NB 且在 2017 年至 2018 年间出现 ASB 或 UTI 诊断的成年人，其就诊记录中包含 ASB 或 UTI 诊断。从 VA 公司数据仓库和医疗记录中提取临床和就诊数据，对 291 名患者中的 300 个就诊进行分层抽样。
无。
总结适当和不适当的 ASB 和 UTI 诊断和治疗的发生率。多变量逻辑回归模型评估了与不恰当管理相关的因素。
纳入了 291 名患者中的 200 次 UTI 就诊和 100 次 ASB 就诊（SCI/D，39.9%；MS，36.4%；PD，23.7%）。大多数患者为男性（83.3%）、＞65 岁（62%）和使用留置或间歇性导尿管（68.3%）。几乎所有的 ASB 就诊都有适当的诊断（98%）。70 次（35%）UTI 就诊的诊断不恰当，其中 55 次（27.5%）为真正的 ASB，均采用不恰当的治疗。在其余 145 次 UTI 就诊中，54 次（27%）治疗不恰当。外周血管疾病、慢性肾脏病和脑血管疾病与不恰当管理的几率增加相关；留置导尿管（优势比[OR]0.35，P=.01）和物理医学与康复提供者（OR0.29，P<.01）与几率降低相关。
多达一半的 NB 患者的 UTI 就诊存在不恰当的管理，主要是由于真正的 ASB 患者的 UTI 诊断不恰当。针对患有合并症且由非康复提供者诊治的复杂患者，应采取干预措施以改善 NB 患者的 ASB 和 UTI 管理。
