Inappropriate diagnosis and treatment of asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) are leading causes of antibiotic overuse but have not been well-studied in patients with risks for complicated UTI such as neurogenic bladder (NB).
Our aim was to describe ASB and UTI management in patients with NB and assess factors associated with inappropriate management.
Retrospective cohort study SETTING: : Four Veteran's Affairs (VA) medical centers PARTICIPANTS: : Adults with NB due to spinal cord injury/disorder (SCI/D), multiple sclerosis (MS), or Parkinson's disease (PD) and encounters with an ASB or UTI diagnosis between 2017-2018. Clinical and encounter data were extracted from the VA Corporate Data Warehouse and medical record reviews for a stratified sample of 300 encounters.
none MAIN OUTCOME MEASURES: : Prevalence of appropriate and inappropriate ASB and UTI diagnosis and treatment was summarized. Multivariable logistic regression models assessed factors associated with inappropriate management.
N=300 encounters (200 UTI; 100 ASB) were included for N=291 unique patients (SCI/D, 39.9%; MS, 36.4%; PD, 23.7%). Most patients were male (83.3%), > 65 years (62%), and used indwelling or intermittent catheterization (68.3%). Nearly all ASB encounters had inappropriate diagnosis (98%). 70 (35%) UTI encounters had inappropriate diagnosis, including 55 (27.5%) with true ASB, all with inappropriate treatment. Among the remaining 145 UTI encounters, 54 (27%) had inappropriate treatment. Peripheral vascular disease, chronic kidney disease, and cerebrovascular disease were associated with increased odds of inappropriate management; indwelling catheter (aOR 0.35, p=0.01) and Physical Medicine & Rehabilitation provider (aOR 0.29, p<0.01) were associated with decreased odds.
Up to half of UTI encounters for patients with NB had inappropriate management, largely due to inappropriate UTI diagnosis in patients with true ASB. Interventions to improve ASB and UTI management in patients with NB should target complex patients with comorbidities being seen by non-rehabilitation providers.
Archives of physical medicine and rehabilitation. 2023 Oct 10 [Epub ahead of print]
Margaret A Fitzpatrick, Marissa Wirth, Stephen P Burns, Katie J Suda, Frances M Weaver, Eileen Collins, Nasia Safdar, Charlesnika T Evans
Center of Innovation for Veteran-Centered and Value-Driven Care, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA; Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. Electronic address: ., Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA., Spinal Cord Injury/Disorders Service, VA Puget Sound Healthcare System, Seattle, WA, USA; Department of Physical Medicine and Rehabilitation, University of Washington School of Medicine, Seattle, WA, USA., Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Department of Medicine, Center for Research on Healthcare, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA; Loyola University Chicago Parkinson School of Health Sciences and Public Health, Maywood, IL, USA., College of Nursing, University of Illinois Chicago, Chicago, IL, USA., Department of Medicine, Division of Infectious Diseases, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA; William S. Middleton VA Hospital, Madison, WI, USA., Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA; Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37827486