Urine culture, asymptomatic bacteriuria and diabetic patients. Is antibiotic prophylaxis always indicated?

2018 ◽  
Vol 17 (8) ◽  
pp. 193
Author(s):  
R. Bartoletti ◽  
T. Di Vico ◽  
J. Durante ◽  
A. Tognarelli ◽  
L. Brizzi ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Diabetic Patients

scholarly journals 10-Year Trends in Urine Testing and Treatment in Patients with Spinal Cord Injury: An Opportunity for Targeted Stewardship

2020 ◽  
Vol 41 (S1) ◽  
pp. s90-s90
Author(s):  
Alison Nelson ◽  
Kalpana Gupta ◽  
Judith Strymish ◽  
Maura Nee ◽  
Katherine Linsenmeyer
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Antibiotic Treatment ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Routine Screening ◽  
Organizational Level ◽  
Cord Injury ◽  
Urine Testing ◽  
Over Time

Background: Guidelines regarding asymptomatic bacteriuria (ASB) have consistently recommended against screening and treatment in most circumstances. However, screening of patients with spinal cord injury (SCI) is common practice and in some cases is a formal protocol at the organizational level. A previous study found that more than one-third of patients with ASB detected on routine screening cultures performed at annual visits in 2012 received antibiotics. However, the role of antibiotic stewardship has become more prominent over the last decade. We hypothesized that diagnostic and therapeutic stewardship efforts may be impacting the practice of annual urine-culture screening for SCI patients. We evaluated urine culture screening and treatment rates over a 10-year period. Methods: Patients with SCI seen in the VA Boston HCS for an annual exam in 2018 were eligible for inclusion and formed the baseline cohort for this study. Annual visits for the cohort over a 10-year period (January 1, 2009–December 31, 2018) were included in the analysis. Electronic data collection and manual chart review were utilized to capture outcomes of interest including urine culture, antibiotic prescriptions and indication within 15 days, and documentation of urinary or infectious symptoms. The main outcomes were (1) rate of urine cultures performed ±3 days of the visit, (2) rate of antibiotic treatment in asymptomatic patients, and (3) trend over time of urine culturing and treating. The χ2 test for trend was used to compare rates over time. Results: In total, 1,962 annual visits were made by the 344 unique patients over the 10-year period and were available for analysis. Among these, 639 (32.6%) visits had a urine culture performed within 3 days. The proportion of visits with a collected culture decreased from (109 of 127) 85.8% of visits in 2009 to (65 of 338) 19.2% of visits in 2018, P ≤ .001 (Fig. 1). In the treatment analysis, 39 visits were excluded for active symptoms, concern for uncontrolled infection, or prophylaxis as antibiotic indication. Among 600 remaining screening cultures, 328 had a bacterial pathogen or >100,000 mixed colonies consistent with ASB. Overall, 51 patients (17%) received antimicrobials. The rate of antibiotic treatment for ASB did not significantly decrease over time pP = 0.79 (Fig. 2). Conclusions: Over a 10-year period of annual SCI visits, the proportion of visits with a urine culture performed as routine screening significantly and consistently decreased. However, the rate of treatment for positive urine cultures remained consistent. These data support targeted diagnostic stewardship in this population to reduce unnecessary antibiotic use.Funding: NoneDisclosures: None

scholarly journals 238. Novel Way to Evaluate Antibiotic Use Appropriateness: Moving Towards the “Never Event” Classification by Electronic Algorithm

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S119-S120
Author(s):  
Twisha S Patel ◽  
Lindsay A Petty ◽  
Jiajun Liu ◽  
Marc H Scheetz ◽  
Nicholas Mercuro ◽  
...  
Keyword(s):  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Use ◽  
Data Capture ◽  
Electronic Data Capture ◽  
Electronic Data ◽  
False Positivity ◽  
Never Event ◽  
Manual Review

Abstract Background Antibiotic use is commonly tracked electronically by antimicrobial stewardship programs (ASPs). Traditionally, evaluating the appropriateness of antibiotic use requires time- and labor-intensive manual review of each drug order. A drug-specific “appropriateness” algorithm applied electronically would improve the efficiency of ASPs. We thus created an antibiotic “never event” (NE) algorithm to evaluate vancomycin use, and sought to determine the performance characteristics of the electronic data capture strategy. Methods An antibiotic NE algorithm was developed to characterize vancomycin use (Figure) at a large academic institution (1/2016–8/2019). Patients were electronically classified according to the NE algorithm using data abstracted from their electronic health record. Type 1 NEs, defined as continued use of vancomycin after a vancomycin non-susceptible pathogen was identified, were the focus of this analysis. Type 1 NEs identified by automated data capture were reviewed manually for accuracy by either an infectious diseases (ID) physician or an ID pharmacist. The positive predictive value (PPV) of the electronic data capture was determined. Antibiotic Never Event (NE) Algorithm to Characterize Vancomycin Use Results A total of 38,774 unique cases of vancomycin use were available for screening. Of these, 0.6% (n=225) had a vancomycin non-susceptible pathogen identified, and 12.4% (28/225) were classified as a Type 1 NE by automated data capture. All 28 cases included vancomycin-resistant Enterococcus spp (VRE). Upon manual review, 11 cases were determined to be true positives resulting in a PPV of 39.3%. Reasons for the 17 false positives are given in Table 1. Asymptomatic bacteriuria (ASB) due to VRE in scenarios where vancomycin was being appropriately used to treat a concomitant vancomycin-susceptible infection was the most common reason for false positivity, accounting for 64.7% of false positive cases. After removing urine culture source (n=15) from the algorithm, PPV improved to 53.8%. Conclusion An automated vancomycin NE algorithm identified 28 Type 1 NEs with a PPV of 39%. ASB was the most common cause of false positivity and removing urine culture as a source from the algorithm improved PPV. Future directions include evaluating Type 2 NEs (Figure) and prospective, real-time application of the algorithm. Disclosures Marc H. Scheetz, PharmD, MSc, Merck and Co. (Grant/Research Support)

scholarly journals Incidence of Bacteriuria after Urodynamic Study with or without Antibiotic Prophylaxis in Women with Urinary Incontinence

2017 ◽  
Vol 39 (10) ◽  
pp. 534-540 ◽  
Author(s):  
Elizabeth Hirakauva ◽  
Ana Bianchi-Ferraro ◽  
Eliana Zucchi ◽  
Marcio Kajikawa ◽  
Manoel Girão ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Placebo Group ◽  
Urinary Tract ◽  
Antibiotic Prophylaxis ◽  
Urine Culture ◽  
Placebo Control ◽  
Urodynamic Study ◽  
Group A ◽  
Group B ◽  
Group D

Introduction The presence of bacteria in urine is called bacteriuria, which may be symptomatic or asymptomatic. The manipulation of the urinary tract during urodynamic study (UDS), which is an invasive procedure, can result in urinary tract infection (UTI). Studies on the use of prophylactic antibiotics for UDSs are contradictory. Some investigators concluded that they were valuable and others did not. The objective of this study is to evaluate the efficacy of antibiotic prophylaxis before UDS. This is a placebo-control randomized double-blind study. Methods Two-hundred and seventeen women affected by urinary incontinence were eligible for this study. All patients had presented negative urine culture previous to the UDS. They were randomized in four groups: group A received placebo, group B received 500 mg of levofloxacin, group C received 80 mg trimethoprim and 400 mg sulfamethoxazole and group D received 100 mg of nitrofurantoin. A urine culture was performed 14 days after the UDS. Results We observed asymptomatic bacteriuria after the UDS in five patients in group A, one in group B, one in group C and one in group D. Only one patient on group A had symptomatic bacteriuria. We didn't observe statistical difference between the groups. When we recategorized the patients in two groups, the incidence of bacteriuria was significantly higher in the placebo group compared with the antibiotic group. Conclusion The conclusion is that antibiotic prophylaxis before the UDS did not reduce the incidence of UTI in women within the target population.

scholarly journals Whole-Genome Draft Sequences of Nine Asymptomatic Escherichia coli Bacteriuria Isolates from Diabetic Patients

2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Christoph Stork ◽  
Beáta Kovács ◽  
Eva Trost ◽  
Tamás Kovács ◽  
György Schneider ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract Infection ◽  
Asymptomatic Bacteriuria ◽  
Diabetic Patients ◽  
Whole Genome ◽  
Genome Sequences ◽  
Disease Response ◽  
Symptomatic Urinary Tract Infection ◽  
E Coli ◽  
Genome Draft

ABSTRACT Escherichia coli can colonize the urinary bladder without causing a disease response in the host. This asymptomatic bacteriuria (ABU) can protect against recurrent symptomatic urinary tract infection by virulent bacteria. Here, we report the whole-genome sequences of nine E. coli ABU isolates from diabetic patients.

scholarly journals Asymptomatic bacteriuria in pregnancy: what is the validity of urine sediment microscopy as a screening tool in a low resource setting?

2020 ◽  
Vol 9 (6) ◽  
pp. 2442
Author(s):  
Rashmi Polnaya ◽  
Amritha Bhandary
Keyword(s):  
Predictive Value ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Urine Sediment ◽  
Predictive Values ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Urine Microscopy ◽  
In Pregnancy

Background: Asymptomatic bacteriuria in pregnancy should be screened and treated to reduce the risk of morbidity and mortality. Urine culture is the recommended test. In low resource setting with large patient load urine culture in all pregnant patients is not feasible. In this study authors have assessed the validity of urine microscopy in the screening of asymptomatic bacteriuria in pregnancy.Methods: Midstream clean catch urine specimen collected from 675 pregnant women was subjected to urine sediment microscopy and culture. It was considered screen positive if pus cells were >5/HPF. Asymptomatic bacteriuria was diagnosed if there were >/=100000 CFU of a single uropathogen per ml. Results obtained were statistically analysed for the prevalence of asymptomatic bacteriuria, sociodemographic and medical risk factors, causative organisms, antibiotic sensitivity and validity of urine sediment microscopy in detecting asymptomatic bacteriuria.Results: The incidence of asymptomatic bacteriuria in our study was 10.2%. The incidence was higher in the age group between 20-30 years, in gravida 3 and above, in upper lower and lower socioeconomic status, in women with hyperglycemia in pregnancy and anaemia. E. coli was the commonest bacterial isolate in culture positive cases. Bacterial isolates had poor sensitivity for Ampicillin, amoxicillin and nitrofurantoin and good sensitivity for cephalosporins and aminoglycosides. The sensitivity, specificity, positive and negative predictive values for urine microscopy was 43%, 85%, 25% and 93% respectively.Conclusions: This study shows poor sensitivity and positive predictive value and good specificity and negative predictive value.

scholarly journals Targeting Asymptomatic Bacteriuria in Antimicrobial Stewardship: the Role of the Microbiology Laboratory

2020 ◽  
Vol 58 (5) ◽  
Author(s):  
Zanthia Wiley ◽  
Jesse T. Jacob ◽  
Eileen M. Burd
Keyword(s):  
Renal Transplant ◽  
Pregnant Women ◽  
Bacterial Species ◽  
Asymptomatic Bacteriuria ◽  
Urine Specimen ◽  
Diabetic Patients ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Cord Injury

ABSTRACT This minireview focuses on the microbiologic evaluation of patients with asymptomatic bacteriuria, as well as indications for antibiotic treatment. Asymptomatic bacteriuria is defined as two consecutive voided specimens (preferably within 2 weeks) with the same bacterial species, isolated in quantitative counts of ≥105 CFU/ml in women, including pregnant women; a single voided urine specimen with one bacterial species isolated in a quantitative count ≥105 CFU/ml in men; and a single catheterized urine specimen with one or more bacterial species isolated in a quantitative count of ≥105 CFU/ml in either women or men (or ≥102 CFU/ml of a single bacterial species from a single catheterized urine specimen). Any urine specimen with ≥104 CFU/ml group B Streptococcus is significant for asymptomatic bacteriuria in a pregnant woman. Asymptomatic bacteriuria occurs, irrespective of pyuria, in the absence of signs or symptoms of a urinary tract infection. The two groups with the best evidence of adverse outcomes in the setting of untreated asymptomatic bacteriuria include pregnant women and patients who undergo urologic procedures with risk of mucosal injury. Screening and treatment of asymptomatic bacteriuria is not recommended in the following patient populations: pediatric patients, healthy nonpregnant women, older patients in the inpatient or outpatient setting, diabetic patients, patients with an indwelling urethral catheter, patients with impaired voiding following spinal cord injury, patients undergoing nonurologic surgeries, and nonrenal solid-organ transplant recipients. Renal transplant recipients beyond 1 month posttransplant should not undergo screening and treatment for asymptomatic bacteriuria. There is insufficient evidence to recommend for or against screening of renal transplant recipients within 1 month, patients with high-risk neutropenia, or patients with indwelling catheters at the time of catheter removal. Unwarranted antibiotics place patients at increased risk of adverse effects (including Clostridioides difficile diarrhea) and contribute to antibiotic resistance. Methods to reduce unnecessary screening for and treatment of asymptomatic bacteriuria aid in antibiotic stewardship.

Asymptomatic bacteriuria in pregnancy: Screening urinalysis or urine culture

1997 ◽  
Vol 176 (1) ◽  
pp. S188
Author(s):  
R. Figueroa ◽  
E. Leikin ◽  
A. Bertkau ◽  
N. Tejani
Keyword(s):  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
In Pregnancy

scholarly journals ANTIBIOTIC PROPHYLAXIS WITH DIFFERENT ANTIBIOTIC REGIMEN IN PROSTATE BIOPSY PATIENTS

2013 ◽  
Vol 20 (1) ◽  
Author(s):  
Dimas Sindhu Wibisono ◽  
Doddy M. Soebadi ◽  
Soetojo Soetojo ◽  
Budiono Budiono
Keyword(s):  
Antibiotic Prophylaxis ◽  
Prostate Biopsy ◽  
Urine Culture ◽  
Blood Levels ◽  
Positive Urine Culture ◽  
Blood Leukocytes ◽  
Biopsy Material ◽  
Reactive Protein ◽  
Significant Difference ◽  
Blood Leukocyte

Objective: To know the incidence of urinary tract infection (UTI) with different antibiotic prophylaxis for transrectal ultrasonography (TRUS) prostate biopsy. Material & Method: The study included 34 patients at Soetomo Hospital Surabaya, who were divided into 2 groups, each group consisting of 17 patients. In the first group patients received 1000 mg of ciprofloxacin orally, in the second group cefotaxime 1000 mg iv was given prior to biopsy. The two groups were compared in terms of UTI incidence as observed from the blood levels of leukocytes, C-reactive protein (CRP) and urine culture 3 days after the procedure. Results: Based on blood leukocyte levels, there was no statistically significant difference between the two groups (p = 0,74 and p = 0,42). So was the comparison of CRP levels. There was no other significant difference found (p = 0,53 and p = 0,27). From the results of urine culture, the ciprofloxacin group had positive urine culture results lower than the cefotaxime group (29,4% : 35,3%), although it was not statistically significant (p = 1,0). Conclusion: Based on the parameters of blood leukocytes levels, CRP and urine culture, there were no differences in the incidence of UTI after biopsy in the two groups.Keywords: TRUS prostate biopsy, UTI, ciprofloxacin, cefotaxime.

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