Discordance between perception and treatment practices associated with intensive care unit-acquired bacteriuria and funguria: a Canadian physician survey.
OBJECTIVE
To determine physician practice and perception about the management of intensive care unit (ICU)-acquired bacteriuria and funguria.


METHODS
Cross-sectional, self-administered, Web-based survey.


METHODS
All provinces within Canada.


METHODS
Staff ICU physicians who are members of either the Canadian Critical Care Trials Group or the Canadian Critical Care Society.


METHODS
Survey items were developed by four ICU clinicians, and survey sensibility was assessed by five independent intensivists. Nonrespondents received three follow-up reminders. Participants were asked questions about general perceptions and practices regarding the management of ICU-acquired bacteriuria and funguria. Clinical scenarios were used to elicit management strategies, including antimicrobial prescriptions.


RESULTS
Ninety of 198 physicians (45%) responded. Bacteriuria was perceived by 63% of the respondents to be a frequent but low-morbidity problem. Most intensivists (98%) did not use a protocol for management. Traditional symptoms were rarely used to interpret the significance of bacteriuria. Presence of systemic inflammatory response syndrome (93%), presence of hemodynamic changes (91%), and urinalysis (69%) were used often. Within clinical scenarios, source control via urinary catheter change was not universal, ranging from 44% to 67% in the various scenarios, even in patients presenting with septic shock. Prescription of antimicrobials was common across scenarios despite the low-morbidity perception. In an asymptomatic patient, 19% of respondents would prescribe antimicrobials. Changing the species from fungus to bacteria and the presence of systemic inflammatory response syndrome or shock increased the likelihood of antimicrobial use up to 70% to 80%.


CONCLUSIONS
ICU physicians perceive bacteriuria to have low morbidity. However, management approaches vary considerably, and systemic antimicrobials are frequently prescribed. Increased clinical instability and bacterial vs. fungal organisms isolated in urine cultures increased the use of antimicrobials. The considerable variability in practice and discordance between likelihood of urinary tract infection and antimicrobial prescription, highlights the need for additional clinical trials.
Chant
Clarence
C
Pharmacy Department, St. Michael's Hospital, Toronto, Ontario, Canada. chantc@smh.toronto.on.ca
Dos Santos
Claudia C
CC
Saccucci
Paola
P
Smith
Orla M
OM
Marshall
John C
JC
Friedrich
Jan O
JO
D001291:Attitude of Health Personnel; D001437:Bacteriuria / Q000188:drug therapy*; D002170:Canada; D003422:Critical Care / Q000379:methods*; D003428:Cross Infection / Q000188:drug therapy* / Q000652:urine; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000652:urine; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D011795:Surveys and Questionnaires