News Release

Evidence vs. practice in managing asymptomatic bacteriuria

Peer-Reviewed Publication

Canadian Medical Association Journal

Despite compelling evidence not to treat asymptomatic bacteriuria in elderly residents of long-term-care facilities, these patients are often treated with antibiotics. To find out why, The authors conducted 4 focus groups with physicians and nurses involved in the process of prescribing antibiotics for such patients.

The authors report that ambiguous signs such as foul-smelling urine and subtle changes in patient behaviour were mentioned as signs for ordering urine cultures and antibiotic therapy. However, studies have shown that the presence of bacteria in urine without urinary symptoms is common among elderly people living in institutional settings, occurring in up to 50% of elderly women and 35% of elderly men. Also, 5 separate randomized trials showed no difference in morbidity or mortality between treated and untreated residents. One such trial showed that antibiotic treatment was associated with more adverse events.

The results of the groups lead Walker and colleagues to several questions for further research, including whether or not better physician and nurse education can reduce the frequency of prescribing antibiotics for asymptomatic bacteriuria.

In a related commentary, Lindsay Nicolle states that while better education is a laudable goal, only restriction and concurrent review lead to sustained improvement in the appropriate use of antimicrobials among the populations in long-term-care facilities.

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Why are antibiotics prescribed for asymptomatic bacteriuria in institutionalized elderly people? -- S. Walker et al

Asymptomatic bacteriuria in institutionalized elderly people: evidence and practice -- L.E. Nicolle

Additional contact: Dr. Lindsay Nicolle, Professor and Head, Department of Internal Medicine, University of Manitoba, Winnipeg; tel 204-787-7772



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