Annals for Hospitalists Inpatient Notes - Innocent Bystander: Leaving Asymptomatic Bacteriuria Alone in Hospitalized Patients
Authors: Lindsay A. Petty, Valerie M. Vaughn, Tejal N. Gandhi
Journal: Annals of Internal Medicine (2020)

Web Exclusives21 July 2020Annals for Hospitalists Inpatient Notes - Innocent Bystander: Leaving Asymptomatic Bacteriuria Alone in Hospitalized PatientsLindsay A. Petty, MD, Valerie M. Vaughn, MD, MSc, and Tejal N. Gandhi, MDLindsay A. Petty, MDUniversity of Michigan, Ann Arbor, Michigan (L.A.P., V.M.V., T.N.G.)Search for more papers by this author, Valerie M. Vaughn, MD, MScUniversity of Michigan, Ann Arbor, Michigan (L.A.P., V.M.V., T.N.G.)Search for more papers by this author, and Tejal N. Gandhi, MDUniversity of Michigan, Ann Arbor, Michigan (L.A.P., V.M.V., T.N.G.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-4261 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail To do nothing at all is the most difficult thing in the world, the most difficult and the most intellectual.—Oscar WildeFor more than 10 years guidelines have recommended against treating asymptomatic bacterial colonization of the urine (asymptomatic bacteriuria [ASB]) with antibiotics. Despite this, 83% of hospitalized patients with ASB are treated inappropriately with antibiotics (1). So, how may hospitalists change their approach to improve outcomes? The following 3 representative cases highlight principles that can help clinicians avoid inappropriate testing and treatment of ASB.Case 1A 70-year-old man with congestive heart failure presents with bilateral lower extremity edema and ...References1. Petty LA, Vaughn VM, Flanders SA, et al. Risk factors and outcomes associated with treatment of asymptomatic bacteriuria in hospitalized patients. JAMA Intern Med. 2019. [PMID: 31449295] doi:10.1001/jamainternmed.2019.2871 CrossrefMedlineGoogle Scholar2. Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68:1611-1615. [PMID: 31506700] doi:10.1093/cid/ciz021 CrossrefMedlineGoogle Scholar3. Branch-Elliman W, O'Brien W, Strymish J, et al. Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse events. JAMA Surg. 2019;154:590-598. [PMID: 31017647] doi:10.1001/jamasurg.2019.0569 CrossrefMedlineGoogle Scholar4. Vaughn VM, Flanders SA, Snyder A, et al. Excess antibiotic treatment duration and adverse events in patients hospitalized with pneumonia: a multihospital cohort study. Ann Intern Med. 2019;171:153-163. [PMID: 31284301]. doi:10.7326/M18-3640 LinkGoogle Scholar5. Mayne S, Bowden A, Sundvall PD, et al. The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing—a systematic literature review. BMC Geriatr. 2019;19:32. [PMID: 30717706] doi:10.1186/s12877-019-1049-7 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Michigan, Ann Arbor, Michigan (L.A.P., V.M.V., T.N.G.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-4261.Corresponding Author: Lindsay A. Petty, MD, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109; e-mail, [email protected]umich.edu.Current Author Addresses: Dr. Petty: University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109.Dr. Vaughn: University of Michigan, 2800 Plymouth Road, Building 16, Room 422W, Ann Arbor, MI 48109.Dr. Gandhi: University of Michigan, F4015 University Hospital South, 1500 East Medical Center Drive, SPC 5226, Ann Arbor, MI 48109. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - 21 July 2020 David H. Wesorick and Vineet Chopra Metrics 21 July 2020Volume 173, Issue 2Page: HO2-HO3KeywordsAntibioticsBacteriaFeversHospitalistsInfectious diseasesIschemiaLength of staySigns and symptomsUrine ePublished: 21 July 2020 Issue Published: 21 July 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...