Boerckel Haley N, Worden Lacy J, Salvati Lisa A, Jameson Andrew P, Dumkow Lisa E
J Am Pharm Assoc (2003). 2024 Jul-Aug;64(4S):102176. doi: 10.1016/j.japh.2024.102176. Epub 2024 Aug 10.
Pyuria is nonspecific and may result in over-treatment of asymptomatic bacteriuria (ASB). The Infectious Diseases Society of America recommends against antibiotic treatment of ASB for most patients including those presenting with altered mental status (AMS). Close observation is recommended over treatment to avoid missing alternative causes of AMS and overuse of antibiotics resulting in adverse events and resistance.
The purpose of this study was to evaluate patient outcomes associated with antibiotic treatment of pyuria in patients presenting with AMS at hospital admission without specific urinary tract infection (UTI) symptoms. The primary objective was to compare 30-day readmission rates of patients with pyuria and AMS treated with antibiotics (AMS+Tx) versus those who were not treated (AMS-NoTx). Secondary outcomes included identifying risk factors for antibiotic treatment, comparing alternative diagnoses for AMS, and comparing safety outcomes.
This retrospective cohort study evaluated adult patients with AMS and pyuria (10 WBC/hpf) admitted between February 1, 2020 and October 1, 2021, in a 350-bed community teaching hospital. Patients with documented urinary symptoms were excluded. Additional exclusion criteria included admission to critical care, history of renal transplant, urological surgery, coinfections, pregnancy, and neutropenia.
Two-hundred patients were included (AMS+Tx, n = 162; AMS-NoTx, n=38). There was no difference in 30-day hospital readmission rate for AMS between groups (AMS+Tx 16.7% vs AMS-NoTx 23.7%, P = 0.311). An alternative diagnosis of AMS occurred more frequently when antibiotics were withheld (AMS+Tx 66% vs. AMS-NoTx 86.8%, P = 0.012). Urinalyses showing bacteria (odds ratio 2.52; 95% CI, 1.11-5.731) and positive urine culture (OR 3.36; 95% CI, 1.46-7.711) were associated with antibiotic prescribing.
Inappropriate antibiotic use is common among hospitalized patients presenting with AMS and pyuria; however, treatment of asymptomatic pyuria did not decrease rates of subsequent readmission for AMS or retreatment of symptomatic UTI. Patients who were monitored off antibiotics had higher rates of alternative AMS diagnosis.
脓尿并无特异性，可能导致对无症状菌尿（ASB）的过度治疗。美国传染病学会建议，对于大多数患者，包括那些出现精神状态改变（AMS）的患者，不建议使用抗生素治疗ASB。建议密切观察而非进行治疗，以避免遗漏AMS的其他病因以及抗生素的过度使用导致不良事件和耐药性。
本研究的目的是评估在入院时出现AMS但无特定尿路感染（UTI）症状的患者中，抗生素治疗脓尿的患者结局。主要目的是比较接受抗生素治疗的脓尿和AMS患者（AMS+Tx）与未接受治疗的患者（AMS-NoTx）的30天再入院率。次要结局包括确定抗生素治疗的风险因素、比较AMS的其他诊断以及比较安全性结局。
这项回顾性队列研究评估了2020年2月1日至2021年10月1日期间在一家拥有350张床位的社区教学医院入院的患有AMS和脓尿（白细胞≥10个/高倍视野）的成年患者。有记录的泌尿系统症状的患者被排除。其他排除标准包括入住重症监护病房、肾移植史、泌尿外科手术史、合并感染、妊娠和中性粒细胞减少症。
共纳入200例患者（AMS+Tx组，n = 162；AMS-NoTx组，n = 38）。两组之间AMS的30天再入院率无差异（AMS+Tx组为16.7%，AMS-NoTx组为23.7%，P = 0.311）。当不使用抗生素时，AMS的其他诊断更频繁出现（AMS+Tx组为66%，AMS-NoTx组为86.8%，P = 0.
