CohortArchives of physical medicine and rehabilitation2018

Routine Urine Testing at the Spinal Cord Injury Annual Evaluation Leads to Unnecessary Antibiotic Use: A Pilot Study and Future Directions.

Felicia Skelton, Larissa Grigoryan, Sally Ann Holmes and 2 others

PMID 29107038

WHAT IT FOUND

Positive urine cultures at spinal cord injury annual evaluations were linked to antibiotic use, even when the culture represented asymptomatic bacteriuria. 36% of those asymptomatic cases were treated, and no clear difference in 60-day health care use was found.

Key findings

0136% of asymptomatic bacteriuria cases identified at annual evaluations were treated with antibiotics.

02A positive urine culture was associated with antibiotic use, regardless of whether signs and symptoms of infection were present.

03There were no statistically significant differences in emergency visits, hospitalizations, later urine cultures, later UTI diagnosis, or urologic complications between those treated for asymptomatic bacteriuria and those not treated.

STILL TO COME

How it was doneWhat they found

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What it does not show

The study looked back at records, so signs and symptoms of infection were only as complete as what was documented. The data are from 2012 to 2013, so current practice may differ. It was a single medical center, so it may not reflect other clinics. Some infections or health care events may have been missed if patients were not seen locally afterward. Chart review cannot show why clinicians ordered tests or antibiotics, or what patients believed.

Declared interests

The publication types list support from the National Institutes of Health and the U.S. government. No author conflicts of interest are stated in the supplied text.

The easy way to misread this

Do not read this as proof that treating asymptomatic bacteriuria prevents infections or complications. It was a retrospective chart review, and no differences in 60-day health care use were found between treated and untreated asymptomatic cases.

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The study

Participants
327 included visits
Certainty of evidence
Low

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    Cite

    Felicia Skelton, Larissa Grigoryan, Sally Ann Holmes, et al. Routine Urine Testing at the Spinal Cord Injury Annual Evaluation Leads to Unnecessary Antibiotic Use: A Pilot Study and Future Directions. Archives of physical medicine and rehabilitation. 2018.

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