Predictive Factors in Asymptomatic Bacteriuria Treatment

Background Asymptomatic bacteriuria (ASB) can often be inappropriately treated with antibiotics. The primary objective was to identify factors associated with antibiotic treatment of ASB. The secondary objective was to identify the prevalence of ASB treatment at our institution before and after Infectious Diseases Society of America (IDSA) updated Clinical Practice Guidelines for the Management of Asymptomatic Bacteriuria in 2019. 1 Methods This is a retrospective chart review of adults admitted to a rural Veterans Affairs Hospital in White River Junction, Vermont, with culture confirmed bacteriuria. Those who did not meet National Healthcare Safety Network criteria for diagnosis of urinary tract infection were classified as having ASB. Results The prevalence of ASB treatment was 58% (n = 61/106). Patients older than 80 years had 3.73 increased odds of receiving antibiotics for ASB (adjusted odds ratio 3.73, 95% confidence interval 1.43–9.71 P < 0.01). Leukocytes >5/hpf on urinalysis (adjusted odds ratio 4.45, confidence interval 1.19–16.57, P = 0.03) was significantly associated with antibiotic treatment in ASB. There was no significant difference between ASB treatment before 2019 versus after 2019. Conclusions Predictors of clinicians treating ASB with antibiotics were most significant in patients older than 80 years and those with leukocytes >5/hpf on urinalysis. The 2019 IDSA guidance on avoiding antibiotic treatment for ASB was not well adopted to clinical practice for hospitalized patients at our institution.