Bacteremia From a Presumed Urinary Source in Hospitalized Adults With Asymptomatic Bacteriuria Article Swipe
Sonali D. Advani
,
David Ratz
,
Jennifer Horowitz
,
Lindsay A Petty
,
Mohamad G. Fakih
,
Kenneth E. Schmader
,
Lona Mody
,
Tawny Czilok
,
Anurag N. Malani
,
Scott A. Flanders
,
Tejal Gandhi
,
Valerie M. Vaughn
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2024.2283
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2024.2283
Importance Guidelines recommend withholding antibiotics in asymptomatic bacteriuria (ASB), including among patients with altered mental status (AMS) and no systemic signs of infection. However, ASB treatment remains common. Objectives To determine prevalence and factors associated with bacteremia from a presumed urinary source in inpatients with ASB with or without AMS and estimate antibiotics avoided if a 2% risk of bacteremia were used as a threshold to prompt empiric antibiotic treatment of ASB. Design, Setting, and Participants This cohort study assessed patients hospitalized to nonintensive care with ASB (no immune compromise or concomitant infections) in 68 Michigan hospitals from July 1, 2017, to June 30, 2022. Data were analyzed from August 2022 to January 2023. Main Outcomes and Measures The primary outcome was prevalence of bacteremia from a presumed urinary source (ie, positive blood culture with matching organisms within 3 days of urine culture). To determine factors associated with bacteremia, we used multivariable logistic regression models. We estimated each patient’s risk of bacteremia and determined what percentage of patients empirically treated with antibiotics had less than 2% estimated risk of bacteremia. Results Of 11 590 hospitalized patients with ASB (median [IQR] age, 78.2 [67.7-86.6] years; 8595 female patients [74.2%]; 2235 African American or Black patients [19.3%], 184 Hispanic patients [1.6%], and 8897 White patients [76.8%]), 8364 (72.2%) received antimicrobial treatment for UTI, and 161 (1.4%) had bacteremia from a presumed urinary source. Only 17 of 2126 patients with AMS but no systemic signs of infection (0.7%) developed bacteremia. On multivariable analysis, male sex (adjusted odds ratio [aOR], 1.45; 95% CI, 1.02-2.05), hypotension (aOR, 1.86; 95% CI, 1.18-2.93), 2 or more systemic inflammatory response criteria (aOR, 1.72; 95% CI, 1.21-2.46), urinary retention (aOR, 1.87; 95% CI, 1.18-2.96), fatigue (aOR, 1.53; 95% CI, 1.08-2.17), log of serum leukocytosis (aOR, 3.38; 95% CI, 2.48-4.61), and pyuria (aOR, 3.31; 95% CI, 2.10-5.21) were associated with bacteremia. No single factor was associated with more than 2% risk of bacteremia. If 2% or higher risk of bacteremia were used as a cutoff for empiric antibiotics, antibiotic exposure would have been avoided in 78.4% (6323 of 8064) of empirically treated patients with low risk of bacteremia. Conclusions and Relevance In patients with ASB, bacteremia from a presumed urinary source was rare, occurring in less than 1% of patients with AMS. A personalized, risk-based approach to empiric therapy could decrease unnecessary ASB treatment.
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- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1001/jamanetworkopen.2024.2283
- https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2816027/advani_2024_oi_240106_1709228327.56877.pdf
- OA Status
- gold
- Cited By
- 10
- References
- 34
- Related Works
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- OpenAlex ID
- https://openalex.org/W4392740322
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4392740322Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1001/jamanetworkopen.2024.2283Digital Object Identifier
- Title
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Bacteremia From a Presumed Urinary Source in Hospitalized Adults With Asymptomatic BacteriuriaWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
-
2024Year of publication
- Publication date
-
2024-03-13Full publication date if available
- Authors
-
Sonali D. Advani, David Ratz, Jennifer Horowitz, Lindsay A Petty, Mohamad G. Fakih, Kenneth E. Schmader, Lona Mody, Tawny Czilok, Anurag N. Malani, Scott A. Flanders, Tejal Gandhi, Valerie M. VaughnList of authors in order
- Landing page
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https://doi.org/10.1001/jamanetworkopen.2024.2283Publisher landing page
- PDF URL
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https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2816027/advani_2024_oi_240106_1709228327.56877.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
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goldOpen access status per OpenAlex
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https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2816027/advani_2024_oi_240106_1709228327.56877.pdfDirect OA link when available
- Concepts
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Bacteremia, Medicine, Urinary system, Internal medicine, Odds ratio, Bacteriuria, Asymptomatic, Antibiotics, Logistic regression, Cohort, Microbiology, BiologyTop concepts (fields/topics) attached by OpenAlex
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10Total citation count in OpenAlex
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2025: 4, 2024: 6Per-year citation counts (last 5 years)
- References (count)
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34Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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