Overprescribing antibiotics can lead to complications in UTI patients with fever, sepsis.
TORONTO—Guidelines are needed for managing positive urine cultures in the ICU because clinicians often prescribe antibiotics inappropriately, researchers reported here at the annual meeting of the Infectious Diseases Society of America.
“Not every patient with a positive culture needs to be treated,” said study investigator Houssein Jahamy, MD, an infectious disease fellow at Wayne State University in Detroit.
“What we have is a set of guidelines for asymptomatic bacteriuria, but there is nothing that addresses positive urine cultures in the ICU. Guidelines are badly needed to decrease inappropriate prescribing, and they could also help decrease the incidence of complications that come from antibiotic use.”
Dr. Jahamy and his colleagues reviewed the records of all adult patients treated for a positive urine culture in the ICU at St. JohnHospital & MedicalCenter in Detroit from November 1, 2004 through March 31, 2005. Treatment for UTI was deemed “appropriate” in patients with urinary symptoms, fever, and/or other manifestations of sepsis without any other sources. The researchers classified antibiotic treatment as “inappropriate” when patients presented without fever/leukocytosis or with fever/leukocytosis due to other conditions.
There were 119 positive urine cultures, of which 29 were excluded be-cause patients died or were discharged prior to urine culture results becoming available. The remaining 90 positive cultures were found among 87 patients. The mean age of the patients was 62.9 years and 89% had an in-dwelling catheter.
Approximately 47% were diabetic and 65% were females. Additionally, 71% had leukocytosis, 38% were febrile, and 20% were septic. The most common reasons for ICU admission included cardiac events (26%), a central nervous system event (21%), and respiratory failure (11%).
Of the 67 patients (74%) treated for UTIs, 34 (50%) had documented or suspected infection with fever and/or leukocytosis. Antibiotic treatment was deemed appropriate in only 31% of the treated subjects; the remaining 69% received inappropriate care.
All untreated patients met the guidelines for withholding treatment of bacteriuria. Patients treated with antibiotics had a higher incidence of diarrhea than those not treated with antibiotics (55% vs. 30%).