Asymptomatic Bacteriuria, Urinary Tract Infections
Conditions
Keywords
Long term care, Urine culture
Brief summary
Asymptomatic bacteriuria (AB) is a condition in which bacteria are detected in urine culture without urinary symptoms. The inappropriate use of antibiotic treatment for AB selects bacterial flora to express resistance mutations. Reducing inappropriate antibiotic use for AB is difficult, since the microbiology laboratory cannot distinguish patients with AB. The investigators study will use a restricted laboratory report requesting the physician to call the laboratory for culture results. The restricted report may reduce the rate of inappropriate treatment of AB.
Detailed description
Positive urine cultures during the study period will be randomized to restricted microbiology laboratory reporting or standard microbiology laboratory reporting. Physician or patient consent will not be collected. Patient records will be assessed by the investigator to determine if patients have AB or urinary tract infection. Physician antibiotic treatment decision in both groups will be collected.
Interventions
BEHAVIORALModified Report
An abbreviated version of the microbiology report indicating that growth is present and the physician should call the lab for further details if clinically important.
Sponsors
Memorial University of Newfoundland
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
1\. Consecutive positive urine cultures collected from patients admitted to Long term care facilities will be included. All methods of urine collection will be included (midstream, in-and-out catheterization, indwelling catheter).
Exclusion criteria
1. Positive urine cultures not collected from Long term care facility patients 2. Pregnancy 3. Antibiotic treatment at the time of collection 4. Patients known to have blood neutrophils \<1.0 within 7 days of urine collection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Asymptomatic Bacteriuria Treated With Antibiotics and Urinary Tract Infection Treated With Antibiotics | 7 days | Number of Participants Who Received Appropriate Antibiotic Treatment |
Countries
Canada
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Modified Reporting Microbiology laboratory will report Positive urine cultures may represent asymptomatic bacteriuria or urinary tract infection. If urinary tract infection is suspected clinically, please call 777-xxxx (researcher mobile phone) for identification and susceptibility results
Modified Report: An abbreviated version of the microbiology report indicating that growth is present and the physician should call the lab for further details if clinically important. | 51 |
| Standard Reporting Microbiology laboratory will report identification and susceptibility results | 49 |
| Total | 100 |
Baseline characteristics
| Characteristic | Modified Reporting | Standard Reporting | Total |
|---|---|---|---|
| Age, Continuous | 76.1 years STANDARD_DEVIATION 12.5 | 74.0 years STANDARD_DEVIATION 17.7 | 75.0 years STANDARD_DEVIATION 15.1 |
| Asymptomatic Bacteriuria | 32 Participants | 30 Participants | 62 Participants |
| Race and Ethnicity Not Collected | — | — | 0 Participants |
| Region of Enrollment Canada | 51 Participants | 49 Participants | 100 Participants |
| Sex: Female, Male Female | 34 Participants | 35 Participants | 69 Participants |
| Sex: Female, Male Male | 17 Participants | 14 Participants | 31 Participants |
| Urinary Tract Infection | 19 Participants | 19 Participants | 38 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 2 / 51 | 0 / 49 |
| other Total, other adverse events | 34 / 51 | 27 / 49 |
| serious Total, serious adverse events | 0 / 51 | 1 / 49 |
Outcome results
Primary
Proportion of Asymptomatic Bacteriuria Treated With Antibiotics and Urinary Tract Infection Treated With Antibiotics
Number of Participants Who Received Appropriate Antibiotic Treatment
Time frame: 7 days
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Modified Reporting | Proportion of Asymptomatic Bacteriuria Treated With Antibiotics and Urinary Tract Infection Treated With Antibiotics | 31 Participants |
| Standard Reporting | Proportion of Asymptomatic Bacteriuria Treated With Antibiotics and Urinary Tract Infection Treated With Antibiotics | 25 Participants |