ArticleOpen forum infectious diseases2020
Assessment of Testing and Treatment of Asymptomatic Bacteriuria Initiated in the Emergency Department.
Article in Open forum infectious diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 28 citations in OpenAlex.
- Article
- Emergency department urine culture stewardship and downstream outcomes: a covariate-adjusted biweekly interrupted time series analysis.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Clinical factors and diagnoses associated with inappropriate urine culture ordering in primary care.Infection control and hospital epidemiology · 2026Article
- Article
- Impact of an Educational Leaflet About Asymptomatic Bacteriuria and Urinary Tract Infection on Antibiotic Preferences Among US Adults ≥65 Years: An Online Randomized Controlled Survey Experiment.Open forum infectious diseases · 2025Article
- A Novel and Reproducible Urinary Diagnostic Framework Reduces Health Care and Antibiotic Utilization for Urinary Tract Infections.Open forum infectious diseases · 2025Article
- Impact of a Pharmacist-Led Emergency Department Urinary Tract Infection Aftercare Program.Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2024Article
- Proposing the "Continuum of UTI" for a Nuanced Approach to Diagnosis and Management of Urinary Tract Infections.The Journal of urology · 2024Article
- Bacteremia From a Presumed Urinary Source in Hospitalized Adults With Asymptomatic Bacteriuria.JAMA network open · 2024Article
- Asymptomatic bacteriuria in critical-access hospitals: Prevalence and patient characteristics driving treatment.Infection control and hospital epidemiology · 2024Article
- Development and validation of an antimicrobial stewardship clinical decision-support tool to improve the management of urinary tract infections versus asymptomatic bacteriuria in hospitalized patients.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Impact of a Multifaceted Intervention on Antibiotic Prescribing for Cystitis and Asymptomatic Bacteriuria in 23 Community Hospital Emergency Departments.Hospital pharmacy · 2023Article
- Antibiotic prescribing in mental health units across the Veterans' Health Administration: How much and how appropriate?Infection control and hospital epidemiology · 2023Article
- An Approach to Improving Compliance of Treatment in Asymptomatic Bacteriuria.Spartan medical research journal · 2023Article
- Outcomes of patients with bacteriuria/pyuria of clinically undetermined significance (BPCUS) treated with antibiotics in 23 community hospital emergency departments.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2023Article
- Leveraging diagnostic stewardship within antimicrobial stewardship programmes.Drugs in context · 2023Review
- Overdiagnosis of urinary tract infection linked to overdiagnosis of pneumonia: a multihospital cohort study.BMJ quality & safety · 2022Article
- Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges.Current infectious disease reports · 2021Article
- De-implementation strategy to reduce overtreatment of asymptomatic bacteriuria in the emergency department: a stepped-wedge cluster randomised trial.Therapeutic advances in infectious diseaseArticle
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Authors and funding
15 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundReducing antibiotic use in patients with asymptomatic bacteriuria (ASB) has been inpatient focused. However, testing and treatment is often started in the emergency department (ED). Thus, for hospitalized patients with ASB, we sought to identify patterns of testing and treatment initiated by emergency medicine (EM) clinicians and the association of treatment with outcomes.
methodsWe conducted a 43-hospital, cohort study of adults admitted through the ED with ASB (February 2018-February 2020). Using generalized estimating equation models, we assessed for (1) factors associated with antibiotic treatment by EM clinicians and, after inverse probability of treatment weighting, (2) the effect of treatment on outcomes.
resultsOf 2461 patients with ASB, 74.4% (N = 1830) received antibiotics. The EM clinicians ordered urine cultures in 80.0% (N = 1970) of patients and initiated treatment in 68.5% (1253 of 1830). Predictors of EM clinician treatment of ASB versus no treatment included dementia, spinal cord injury, incontinence, urinary catheter, altered mental status, leukocytosis, and abnormal urinalysis. Once initiated by EM clinicians, 79% (993 of 1253) of patients remained on antibiotics for at least 3 days. Antibiotic treatment was associated with a longer length of hospitalization (mean 5.1 vs 4.2 days; relative risk = 1.16; 95% confidence interval, 1.08-1.23) and
conclusionsAmong hospitalized patients ultimately diagnosed with ASB, EM clinicians commonly initiated testing and treatment; most antibiotics were continued by inpatient clinicians. Antibiotic treatment was not associated with improved outcomes, whereas it was associated with prolonged hospitalization and CDI. For best impact, stewardship interventions must expand to the ED.
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