title: Treatment for Positive Urine Cultures in Hospitalized Adults: A Survey of Prevalence and Risk Factors in 3 Medical Centers.
abstract: BACKGROUND
  Antibiotic treatment for asymptomatic bacteriuria (ASB) is prevalent but often contrary to published guidelines.
  
  
  OBJECTIVE
  To evaluate risk factors for treatment of ASB.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  A tertiary academic hospital, county hospital, and community hospital.
  
  
  METHODS
  Hospitalized adults with bacteriuria.
  
  
  METHODS
  Patients without documented symptoms of urinary tract infection per Infectious Diseases Society of America (IDSA) criteria were classified as ASB. We examined ASB treatment risk factors as well as broad-spectrum antibiotic usage and quantified diagnostic concordance between IDSA and National Healthcare Safety Network criteria.
  
  
  RESULTS
  Among 300 patients with bacteriuria, ASB was present in 71% by IDSA criteria. By National Healthcare Safety Network criteria, 71% of patients had ASB; within-patient diagnostic concordance with IDSA was moderate (kappa, 0.52). After excluding those given antibiotics for nonurinary indications, antibiotics were given to 38% (62/164) with ASB. Factors significantly associated with ASB treatment were elevated urine white cell count (65 vs 24 white blood cells per high-powered field, P<.01), hospital identity (hospital C vs A, odds ratio, 0.34 [95% CI, 0.14-0.80], P =.01), presence of leukocyte esterase (5.48 [2.35-12.79], P<.01), presence of nitrites (2.45 [1.11-5.41], P=.03), and Escherichia coli on culture (2.4 [1.2-4.7], P=.01). Of patients treated for ASB, broad-spectrum antibiotics were used in 84%.
  
  
  CONCLUSIONS
  ASB treatment was prevalent across settings and contributed to broad-spectrum antibiotic use. Associating abnormal urinalysis results with the need for antibiotic treatment regardless of symptoms may drive unnecessary antibiotic use.
authors.affiliation: 1Department of Hospital Epidemiology,Cedars-Sinai Medical Center,Los Angeles,California.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Grein
authors.affiliation: 2David Geffen School of Medicine,Division of General Internal Medicine and Health Services Research,University of California-Los Angeles (UCLA),California.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
authors.affiliation: 3Division of Infectious Diseases,Harbor-UCLA Medical Center,and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center,Los Angeles,California.
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Eells
authors.affiliation: 6Cedars-Sinai/UCLA Multicampus Fellowship Program in Infectious Diseases,Los Angeles,California.
authors.forename: Seong K
authors.initials: SK
authors.lastname: Choi
authors.affiliation: 7Department of Medicine,Harbor-UCLA Medical Center,Torrance,California.
authors.forename: Marianne
authors.initials: M
authors.lastname: Go-Wheeler
authors.affiliation: 7Department of Medicine,Harbor-UCLA Medical Center,Torrance,California.
authors.forename: Tanzib
authors.initials: T
authors.lastname: Hossain
authors.affiliation: 9College of Pharmacy,Western University of Health Sciences,Pomona,California.
authors.forename: Maya Y
authors.initials: MY
authors.lastname: Riva
authors.affiliation: 3Division of Infectious Diseases,Harbor-UCLA Medical Center,and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center,Los Angeles,California.
authors.forename: Megan H
authors.initials: MH
authors.lastname: Nguyen
authors.affiliation: 1Department of Hospital Epidemiology,Cedars-Sinai Medical Center,Los Angeles,California.
authors.forename: A
authors.initials: A
authors.lastname: Rekha Murthy
authors.affiliation: 3Division of Infectious Diseases,Harbor-UCLA Medical Center,and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center,Los Angeles,California.
authors.forename: Loren G
authors.initials: LG
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001437:Bacteriuria / Q000175:diagnosis* / Q000453:epidemiology*; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D014481:United States; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents