Management of Asymptomatic Bacteriuria and Urinary Tract Infections in Patients With Neurogenic Bladder and Factors Associated With Inappropriate Diagnosis and Treatment.
Margaret A Fitzpatrick, Marissa Wirth, Stephen P Burns and 5 others
PMID 37827486WHAT IT FOUND
In veterans with neurogenic bladder, over a third of UTI diagnoses were actually asymptomatic bacteriuria treated with unnecessary antibiotics.
Nearly half of true UTIs received inappropriate treatment, often broad-spectrum drugs. Patients seen by rehab specialists had lower rates of errors.
Key findings
01Over a third of UTI encounters had inappropriate diagnosis, mainly because patients actually had asymptomatic bacteriuria.
02Among the remaining true UTI encounters, 27.0% had inappropriate treatment.
03Being seen by a Physical Medicine & Rehabilitation or SCI provider was associated with decreased odds of inappropriate asymptomatic bacteriuria treatment.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was conducted within the Veterans Health Administration, which mandates annual urine cultures for spinal cord injury patients. This may not reflect practices in other health systems where routine screening is less common. Diagnoses relied on ICD-10 codes and chart documentation, which may be inaccurate. Identifying UTI symptoms in patients with impaired sensation is difficult, which may have affected the accuracy of categorizing encounters as asymptomatic bacteriuria versus true UTI.
Declared interests
Funded by the U.S. Department of Veterans Affairs.
The easy way to misread this
Do not assume that a positive urine culture in a patient with neurogenic bladder requires antibiotic treatment. In this study, many patients treated for UTI actually had asymptomatic bacteriuria, which guidelines recommend against treating unless specific signs of infection are present.