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Current Opinion in Infectious Diseases Feb 2010The aim of this article is to review recent publications concerning the management of catheter-associated urinary tract infection (CAUTI), including the issues of... (Review)
Review
PURPOSE OF REVIEW
The aim of this article is to review recent publications concerning the management of catheter-associated urinary tract infection (CAUTI), including the issues of diagnosis and prevention. Articles reviewed include the various guidelines concerning CAUTI released recently by multiple organizations.
RECENT FINDINGS
There has been a recent upsurge of interest in prevention of CAUTI and a proliferation of guidelines in this area. Social changes in US government reimbursement to hospitals and public reporting of hospital-acquired infections may underlie this interest. The awareness that CAUTI and catheter-associated asymptomatic bacteriuria are distinct conditions is increasing, but unnecessary treatment of asymptomatic bacteriuria remains quite prevalent. The focus in recent CAUTI literature is on prevention, often through strategies to minimize urinary catheter use. Very little new evidence is available to guide diagnosis and treatment strategies.
SUMMARY
Interpretation of many studies of CAUTI is impeded by the failure to distinguish between symptomatic CAUTI and asymptomatic bacteriuria in the study outcomes. This distinction currently relies on clinical symptoms and is not easily made, even with the help of various guidelines. Many aspects of the management of CAUTI merit further study, and the current interest in CAUTI is likely to lead to exciting advances in this field.
Topics: Bacteriuria; Catheter-Related Infections; Humans; Urinary Tract Infections
PubMed: 19926986
DOI: 10.1097/QCO.0b013e328334dda8 -
The Canadian Veterinary Journal = La... Jan 2023To determine if factors associated with urothelial damage and inflammation, including urinary catheterization, urinary obstruction, and urolithiasis are associated with...
OBJECTIVE
To determine if factors associated with urothelial damage and inflammation, including urinary catheterization, urinary obstruction, and urolithiasis are associated with the presence of enterococcal bacteriuria in cats.
ANIMALS
Thirty-one cats with spp. bacteriuria and 31 cats with bacteriuria.
PROCEDURE
A retrospective case-control study with cases and controls identified by records search for spp. (case) and (control) bacteriuria from August 1, 2014 to July 31, 2019. Cases and controls were balanced with respect to average age. Binary logistic regression was used to estimate and test whether the odds of having spp. bacteriuria (instead of ) were associated with the presence of any characteristic.
RESULTS
Urinary catheterization, urinary obstruction, and urolithiasis were not observed more often in cases controls (19% 25%, = 0.543; 19% 32%, = 0.244; and 16% 16%, = 1, respectively). Signs of lower urinary tract disease were significantly less common in cases than in controls (OR: 0.30; 95% CI: 0.10 to 0.83, = 0.02). Hematuria was significantly less common in cases than controls ( = 0.048).
CONCLUSION
No association was identified between urinary catheterization, urolithiasis, or any other comorbidities (hyperthyroidism, chronic kidney disease) and enterococcal bacteriuria in cats.
CLINICAL RELEVANCE
Unlike in humans and dogs, urothelial damage and inflammation caused by factors such as urinary catheterization and urolithiasis may not be the mechanism for enterococcal bacteriuria in cats.
Topics: Animals; Cats; Bacteriuria; Case-Control Studies; Cat Diseases; Enterococcus; Escherichia coli; Inflammation; Retrospective Studies; Risk Factors; Urethral Diseases; Urinary Tract Infections; Urolithiasis
PubMed: 36593937
DOI: No ID Found -
British Medical Journal Mar 1969
Topics: Bacteriuria; Female; Humans; Mass Screening; Urinary Tract Infections
PubMed: 5774072
DOI: No ID Found -
British Medical Journal Mar 1969
Topics: Adult; Bacteriuria; Clinical Laboratory Techniques; Diagnosis; Endocarditis, Subacute Bacterial; Humans; Male
PubMed: 5769872
DOI: 10.1136/bmj.1.5646.778-c -
BMJ Open Mar 2019To systematically review screening and treatment effectiveness, and patient preferences, to inform recommendations by the Canadian Task Force on Preventive Health Care...
OBJECTIVE
To systematically review screening and treatment effectiveness, and patient preferences, to inform recommendations by the Canadian Task Force on Preventive Health Care on screening for asymptomatic bacteriuria in pregnancy.
DESIGN
We searched multiple databases (inception to September 2017) and grey literature sources for studies on screening effectiveness and patient preferences. For treatment with antibiotics, we searched three databases for systematic reviews and obtained search results of the Cochrane Pregnancy and Childbirth Group's Trials Register to update a Cochrane review. Study selection, risk of bias assessment and evaluation of the quality for each outcome using Grading of Recommendations Assessment, Development and Evaluation was completed independently by two reviewers with consensus. Meta-analysis was conducted when appropriate as were analyses based on planned subgroup variables.
OUTCOMES
For screening and treatment effectiveness: maternal and perinatal mortality, maternal and neonatal sepsis, pyelonephritis, spontaneous abortion, preterm delivery, low birth weight and serious adverse events. Valuation of outcomes for patient preferences.
RESULTS
Four studies compared outcomes before and after the introduction of a screening programme or between different screening programmes. All evidence on screening effectiveness was considered very low quality. Women have conflicting opinions about antibiotic use during pregnancy. Fifteen trials compared antibiotic treatment with no treatment or placebo in women with confirmed bacteriuria. Low-quality evidence found that treatment lowered rates of pyelonephritis (12 trials, relative risk [RR] 0.24; 95% CI 0.13 to 0.42; absolute risk reduction [ARR] 17.6%; number needed to treat [NNT] 6, 95% CI 5 to 7) and low birth weight (seven trials, RR 0.63; 95% CI 0.45 to 0.90; ARR 4.4%; NNT 23, 95% CI 15 to 85).
CONCLUSIONS
Antibiotic treatment for women having significant bacteriuria likely reduces the incidence of pyelonephritis and low birth weight, but we are uncertain about the magnitude of the effect and about the extent to which we can apply these results to asymptomatic populations and screening programmes.
PROSPERO REGISTRATION NUMBER
CRD42016045263.
Topics: Anti-Bacterial Agents; Asymptomatic Diseases; Bacteriuria; Female; Humans; Mass Screening; Patient Preference; Pregnancy; Pregnancy Complications, Infectious; Treatment Outcome
PubMed: 30872538
DOI: 10.1136/bmjopen-2017-021347 -
Revista Espanola de Quimioterapia :... Aug 2022To determine the epidemiological characteristics of significative bacteriuria (SB) and their relationship with sociodemographic factors and to analyze risk factors in...
OBJECTIVE
To determine the epidemiological characteristics of significative bacteriuria (SB) and their relationship with sociodemographic factors and to analyze risk factors in inpatients.
METHODS
Cross-sectional descriptive study carried out on urine culture samples received between 2016-2020 in the Microbiology laboratory, differentiating between minors and adults. The dependent variable was the presence of SB and the independent variables were age, sex, year, type of sample and source of the sample. In urine cultures of inpatients, risk factors were evaluated from the Minimum Basic Data Set.
RESULTS
A total of 68,587 valid records (96.3% of the total) were analyzed. 40.8% (95% CI: 40.4%-41.2%) of urine cultures in adults and 33.8% (95% CI: 32.9%-34.7%) in children were positive, with an incidence that ranged in adults between 18.2 cases/1,000 inhabitants in 2016 and 14.6 cases/1,000 inhabitants in 2020 and 21.1 and 8.4 cases/1,000 inhabitants respectively in minors. Positive urine cultures were more frequent in children from urban areas compared to rural areas (OR=1.37; p<0.01). In hospitalized adults, for each year of age the risk of SB increased by 2%, it was 36% higher in women, 18% higher in obese patients and 17% more frequent in patients with kidney disease, (p<0.01). No relationship was observed between SB and diagnosis of COVID-19.
CONCLUSIONS
The sociodemographic characteristics of the population with SB in our health area are similar to those found in other geographical areas worldwide, observing a decreasing trend in incidence in the years studied. The frequency of SB in children is higher in urban areas.
Topics: Adult; Bacteriuria; COVID-19; Child; Cross-Sectional Studies; Female; Humans; Incidence; Risk Factors
PubMed: 35658328
DOI: 10.37201/req/016.2022 -
Infection Control and Hospital... Jun 2023Asymptomatic bacteriuria (ASB) is common among hospitalized patients and often leads to inappropriate antimicrobial use. Data from critical-access hospitals are...
Asymptomatic bacteriuria (ASB) is common among hospitalized patients and often leads to inappropriate antimicrobial use. Data from critical-access hospitals are underrepresented. To target antimicrobial stewardship efforts, we measured the point prevalence of ASB and detected a high frequency of ASB overtreatment across academic, community, and critical-access hospitals.
Topics: Humans; Bacteriuria; Prevalence; Anti-Bacterial Agents; Anti-Infective Agents; Hospitals
PubMed: 35732618
DOI: 10.1017/ice.2022.143 -
American Family Physician Sep 2006A common dilemma in clinical medicine is whether to treat asymptomatic patients who present with bacteria in their urine. There are few scenarios in which antibiotic... (Review)
Review
A common dilemma in clinical medicine is whether to treat asymptomatic patients who present with bacteria in their urine. There are few scenarios in which antibiotic treatment of asymptomatic bacteruria has been shown to improve patient outcomes. Because of increasing antimicrobial resistance, it is important not to treat patients with asymptomatic bacteriuria unless there is evidence of potential benefit. Women who are pregnant should be screened for asymptomatic bacteriuria in the first trimester and treated, if positive. Treating asymptomatic bacteriuria in patients with diabetes, older persons, patients with or without indwelling catheters, or patients with spinal cord injuries has not been found to improve outcomes.
Topics: Adult; Anti-Infective Agents; Bacteriuria; Catheters, Indwelling; Diabetes Complications; Female; Humans; Male; Pregnancy; Pregnancy Complications, Infectious; Risk Factors; Spinal Cord Injuries
PubMed: 17002033
DOI: No ID Found -
The Cochrane Database of Systematic... Sep 2010Asymptomatic bacteriuria occurs in 5% to 10% of pregnancies and, if left untreated, can lead to serious complications. (Review)
Review
BACKGROUND
Asymptomatic bacteriuria occurs in 5% to 10% of pregnancies and, if left untreated, can lead to serious complications.
OBJECTIVES
To assess which antibiotic is most effective and least harmful as initial treatment for asymptomatic bacteriuria in pregnancy.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2010) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomized controlled trials comparing two antibiotic regimens for treating asymptomatic bacteriuria.
DATA COLLECTION AND ANALYSIS
Review authors independently screened the studies for inclusion and extracted data.
MAIN RESULTS
We included five studies involving 1140 women with asymptomatic bacteriuria. We did not perform meta-analysis; each trial examined different antibiotic regimens and so we were not able to pool results. In a study comparing a single dose of fosfomycin trometamol 3 g with a five-day course of cefuroxime, there was no significant difference in persistent infection (risk ratio (RR) 1.36, 95% confidence interval (CI) 0.24 to 7.75), shift to other antibiotics (RR 0.08, 95% CI 0.00 to 1.45), or in allergy or pruritus (RR 2.73, 95% CI 0.11 to 65.24). A comparison of seven-day courses of 400 mg pivmecillinam versus 500 mg ampicillin, both given four times daily, showed no significant difference in persistent infection at two weeks or recurrent infection, but there was an increase in vomiting (RR 4.57, 95% CI 1.40 to 14.90) and women were more likely to stop treatment early with pivmecillinam (RR 8.82, 95% CI 1.16 to 66.95). When cephalexin 1 g versus Miraxid(R) (pivmecillinam 200 mg and pivampicillin 250 mg) were given twice-daily for three days, there was no significant difference in persistent or recurrent infection. A one- versus seven-day course of nitrofurantoin resulted in more persistent infection with the shorter course (RR 1.76, 95% CI 1.29 to 2.40), but no significant difference in symptomatic infection at two weeks, nausea, or preterm birth. Comparing cycloserine with sulphadimidine, no significant differences in symptomatic, persistent, or recurrent infections were noted.
AUTHORS' CONCLUSIONS
We cannot draw any definite conclusion on the most effective and safest antibiotic regimen for the initial treatment of asymptomatic bacteriuria in pregnancy. One study showed advantages with a longer course of nitrofurantoin, and another showed better tolerability with ampicillin compared with pivmecillinam; otherwise, there was no significant difference demonstrated between groups treated with different antibiotics. Given this lack of conclusive evidence, it may be useful for clinicians to consider factors such as cost, local availability and side effects in the selection of the best treatment option.
Topics: Anti-Bacterial Agents; Bacteriuria; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Randomized Controlled Trials as Topic
PubMed: 20824868
DOI: 10.1002/14651858.CD007855.pub2 -
Annals of Internal Medicine Jul 2008Asymptomatic bacteriuria is common, and screening for this condition in pregnant women is a well-established, evidence-based standard of current medical practice.... (Review)
Review
BACKGROUND
Asymptomatic bacteriuria is common, and screening for this condition in pregnant women is a well-established, evidence-based standard of current medical practice. Screening other groups of adults has not been shown to improve outcomes.
PURPOSE
To review new and substantial evidence on screening for asymptomatic bacteriuria, to support the work of the U.S. Preventive Services Task Force.
DATA SOURCES
English-language studies of adults (age >18 years) indexed in PubMed and the Cochrane Library and published from 1 January 2002 through 30 April 2007.
STUDY SELECTION
For benefits of screening or treatment for screened populations, systematic reviews; meta-analyses; and randomized, controlled trials were included. For harms of screening, systematic reviews; meta-analyses; randomized, controlled trials; cohort studies; case-control studies; and case series of large multisite databases were included. Two reviewers independently reviewed titles, abstracts, and full articles for inclusion.
DATA EXTRACTION
Two reviewers extracted data from studies on benefits of screening and treatment (including decreases in the incidence of adverse maternal and fetal outcomes, symptomatic urinary tract infections, hypertension, and renal function decline).
DATA SYNTHESIS
An updated Cochrane systematic review of 14 randomized, controlled trials of treatment supports screening for asymptomatic bacteriuria in pregnant women. A randomized, controlled trial and a prospective cohort study show that screening nonpregnant women with diabetes for asymptomatic bacteriuria is unlikely to produce benefits. No new evidence on screening men for asymptomatic bacteriuria or on harms of screening was found.
LIMITATION
The focused search strategy may have missed some smaller studies on the benefits and harms of screening for asymptomatic bacteriuria.
CONCLUSION
The available evidence continues to support screening for asymptomatic bacteriuria in pregnant women, but not in other groups of adults.
Topics: Adult; Bacteriuria; Female; Humans; Male; Mass Screening; Pregnancy; Pregnancy Complications, Infectious
PubMed: 18591632
DOI: 10.7326/0003-4819-149-1-200807010-00009-w1