Trial reportJournal of the American Geriatrics Society2026
Antibiotics for Delirium in Older Adults With No Clear Urinary Tract Infection: A Multicentre, Pragmatic, Randomized Trial-Vanguard Results.
Trial report in Journal of the American Geriatrics Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Antibiotics for Delirium in Older Adults With No Clear Urinary Tract Infection: A Multicentre, Pragmatic, Randomized Trial-Vanguard Results.Journal of the American Geriatrics Society · 2026Trial
- Defining a Non-Inferiority Margin for Delirium Resolution in a Clinical Trial of Older Adults With Bacteriuria and Abnormal Urine Tests.Journal of the American Geriatrics Society · 2026Article
Corrections and comments
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Authors and funding
16 authors.
Funding
Abstract
backgroundIt is unclear whether antibiotics improve outcomes for older adults with delirium who have pyuria or bacteriuria in the absence of other signs or symptoms of a urinary tract infection.
methodsOur study is a multicenter, parallel-group, single-blinded, non-inferiority pragmatic randomized trial. The trial included a vanguard phase of the first 30 participants, and herein we report the aggregate results from this phase. We included hospitalized adults aged 60 years and older who had delirium and pyuria and/or bacteriuria. We excluded patients with fever, upper or lower urinary tract symptoms, an indwelling foley for more than 72 h, more than 24 h of antibiotics at the time of eligibility, or another indication for antibiotics (e.g., pneumonia). The main outcomes of the vanguard phase were rates of participant recruitment, protocol adherence, and study withdrawal. Our initial goals were 4 patients randomized monthly per site, greater than 95% adherence to allocation, and less than 5% withdrawal rate.
resultsThe median age was 86 years (interquartile range [IQR] 81-92), 68% were female, and most (79%) had either minor or major neurocognitive impairment. Of the participating sites that recruited at least one participant, the recruitment rates ranged from 0.05 to 1.8 participants per month. Adherence to allocation was 100%. Two participants (6.7%) withdrew. For participants randomized to receive antibiotics, the median duration was 5 days (IQR 5-7). By Day 7, delirium had resolved in 39% of the participants who remained hospitalized; 25% of participants were discharged, 32% had ongoing delirium, and 4% did not have a delirium assessment available. By Day 7, 1 (3.6%) developed C. difficile , 1 (3.6%) died, and 1 (3.6%) developed bacteremia.
conclusionWe completed our vanguard phase with 100% adherence to allocation and withdrawal was near the target of 5%. The recruitment rate varied widely and overall was lower than anticipated.
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