Bacteriuria and excess mortality: what should the next steps be?
Population studies have been reviewed that demonstrate that bacteriuria confers an increased risk of earlier death and that this risk is greater in older-age groups. Whether this relationship is due to the capacity of bacteria to infect selectively those who are already seriously ill or is a direct consequence of the presence of bacteria remains to be decided. However, studies have already demonstrated that the excess mortality associated with bacteriuria in hospitalized patients with indwelling catheters can be greatly reduced by simple devices that prevent bacteriuria and that this reduction in rates of bacteriuria is accompanied by a corresponding significant decline in associated mortality. The time is therefore right for a large-scale, controlled clinical trial of the effect on mortality of treatment of bacteriuria in older-age populations. However, such a trial cannot be conducted in the manner in which such studies have been conducted in the past--i.e., with a single course of treatment given over a brief time as the only method of therapy. Instead, more individualized treatment will be necessary if the effect of bacteriuria on mortality in the general population is to be investigated in a scientifically sound manner.
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001437:Bacteriuria / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D002408:Catheters, Indwelling / Q000009:adverse effects; D002986:Clinical Trials as Topic; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007563:Jamaica; D008297:Male; D012306:Risk; D014852:Wales
D000900:Anti-Bacterial Agents