Routine Urine Testing at the Spinal Cord Injury Annual Evaluation Leads to Unnecessary Antibiotic Use: A Pilot Study and Future Directions.
Objectives To measure the prevalence of asymptomatic bacteriuria (ASB) in persons with spinal cord injury (SCI) at the time of their annual examination and to examine the effect on urine testing during the annual examination on subsequent antibiotic use. Design Retrospective cohort study. Setting A...
| Publicado en: | Archives of Physical Medicine & Rehabilitation Vol. 99; no. 2; pp. 219 - 226 |
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| Autores principales: | , , , , |
| Formato: | research Journal Article |
| Publicado: |
W B Saunders
Feb2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=127758726&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 127758726 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00039993 1XL jtl: Archives of Physical Medicine & Rehabilitation issn: 00039993 maglogo: N pubinfo: dt: Feb2018 vid: 99 iid: 2 pid: 1351 pub: W B Saunders place: Philadelphia, Pennsylvania artinfo: ui: 127758726 127758726 127758726 10.1016/j.apmr.2017.10.005 127758726 ppf: 219 ppct: 7 formats: tig: atl: Routine Urine Testing at the Spinal Cord Injury Annual Evaluation Leads to Unnecessary Antibiotic Use: A Pilot Study and Future Directions. aug: au: Skelton, Felicia Grigoryan, Larissa Holmes, Sally Ann Poon, Ivy Oiyee Trautner, Barbara affil: Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX sug: subj: Spinal Cord Injuries Urinalysis Antibiotics Administration and Dosage Health Services Misuse Human Pilot Studies Bacteriuria Drug Therapy Retrospective Design Veterans Outpatients Descriptive Statistics Urinary Tract Infections Drug Therapy Bacteriuria Classification Nitrites Urine Urease Bacteria Classification Catheters, Urinary Bowel and Bladder Management Hematuria ab: Objectives To measure the prevalence of asymptomatic bacteriuria (ASB) in persons with spinal cord injury (SCI) at the time of their annual examination and to examine the effect on urine testing during the annual examination on subsequent antibiotic use. Design Retrospective cohort study. Setting A major SCI center. Participants Veterans (N=393) with SCI seen for an outpatient annual evaluation in 2012 or 2013. Interventions Not applicable. Main Outcome Measures Antibiotic use for bacteriuria within 7 days of the annual evaluation encounter. Results There were 327 clinic visits that met inclusion criteria; of these 327 veterans, 249 had a urine culture performed. A total of 171 urine cultures (69%) were positive for bacteria, of which 22 (13%) represented urinary tract infection (UTI) cases and 149 (87%) were ASB cases. More than a third of the ASB cases (n=53 [36%]) were treated with antibiotics. None of the 78 visits with negative urine cultures received antibiotics to treat the UTI; thus, a positive urine culture alone was associated with antibiotic use ( P <.01). Factors predicting antibiotic use were higher age, nitrite presence on urinalysis, and urease-producing organism on culture media. When comparing bladder management strategies, indwelling catheterization was found to be associated with higher levels of pyuria and hematuria than did spontaneous voiding or intermittent catheterization ( P <.01). Conclusions Two-thirds of the urine cultures of persons with SCI presenting for their annual examination were positive. Most of the positive cultures represented ASB cases, and more than a third of these were treated with antibiotics. A better understanding of the mandate for urine testing at the annual examination and the outcomes of this practice is an important first step in developing antibiotic stewardship for UTI in persons with SCI. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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