Stall Nathan M, Kandel Christopher, Reppas-Rindlisbacher Christina, Quinn Kieran L, Wiesenfeld Lesley, MacFadden Derek R, Johnstone Jennie, Fralick Michael
Division of General Internal Medicine and Geriatrics, Sinai Health and the University Health Network, Toronto, Canada.
Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Canada.
J Am Geriatr Soc. 2024 Aug;72(8):2566-2578. doi: 10.1111/jgs.18964. Epub 2024 Jun 19.
It is unclear whether antibiotics impact delirium outcomes in older adults with pyuria or bacteriuria in the absence of systemic signs of infection or genitourinary symptoms.
We registered our systematic review protocol with PROSPERO (CRD42023418091). We searched the Medline and Embase databases from inception until April 2023 for studies investigating the impact of antimicrobial treatment on the duration and severity of delirium in older adults (≥60 years) with pyuria (white blood cells detected on urinalysis or dipstick) or bacteriuria (bacteria growing on urine culture) and without systemic signs of infection (temperature > 37.9C [>100.2F] or 1.5C [2.4F] increase above baseline temperature, and/or hemodynamic instability) or genitourinary symptoms (acute dysuria or new/worsening urinary symptoms). Two reviewers independently screened search results, abstracted data, and appraised the risk of bias. Full-text randomized controlled trials (RCTs) and observational study designs were included without restriction on study language, duration, or year of publication.
We screened 984 citations and included 4 studies comprising 652 older adults (mean age was 84.6 years and 63.5% were women). The four studies were published between 1996 and 2022, and included one RCT, two prospective observational cohort studies, and one retrospective chart review. None of the four studies demonstrated a significant effect of antibiotics on delirium outcomes, with two studies reported a worsening of outcomes among adults who received antibiotics. The three observational studies included had a moderate or serious overall risk of bias, while the one RCT had a high overall risk of bias.
Our systematic review found no evidence that treatment with antibiotics is associated with improved delirium outcomes in older adults with pyuria or bacteriuria and without systemic signs of infection or genitourinary symptoms. Overall, the evidence was limited, largely observational, and had substantial risk of bias.
在没有感染的全身症状或泌尿生殖系统症状的情况下，抗生素是否会影响老年脓尿或菌尿患者的谵妄转归尚不清楚。
我们在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42023418091）登记了系统评价方案。我们检索了Medline和Embase数据库，从建库至2023年4月，以查找研究抗菌治疗对老年（≥60岁）脓尿（尿液分析或试纸检测发现白细胞）或菌尿（尿培养有细菌生长）且无感染全身症状（体温>37.9℃[>100.2°F]或比基线体温升高1.5℃[2.4°F]及/或血流动力学不稳定）或泌尿生殖系统症状（急性排尿困难或新出现/加重的泌尿系统症状）患者谵妄持续时间和严重程度影响的研究。两名研究者独立筛选检索结果、提取数据并评估偏倚风险。纳入全文随机对照试验（RCT）和观察性研究设计，对研究语言、持续时间或发表年份无限制。
我们筛选了984篇文献，纳入4项研究，共652名老年人（平均年龄84.6岁，63.5%为女性）。这4项研究发表于1996年至2022年之间，包括1项RCT、2项前瞻性观察性队列研究和1项回顾性病历审查。4项研究均未显示抗生素对谵妄转归有显著影响，2项研究报告接受抗生素治疗的成年人转归恶化。纳入的3项观察性研究总体偏倚风险为中度或严重，而1项RCT总体偏倚风险高。
我们的系统评价未发现证据表明，对于老年脓尿或菌尿且无感染全身症状或泌尿生殖系统症状的患者，使用抗生素治疗可改善谵妄转归。总体而言，证据有限，主要为观察性研究，且存在较大偏倚风险。
