Reducing Antibiotic Consumption in Patients with Asymptomatic Bacteriuria: A Bi-directional Approach
[Thesis]
Mozafarihashjin, Mohammad
McGeer, Allison Joan
University of Toronto (Canada)
2019
146 p.
M.Sc.
University of Toronto (Canada)
2019
Objectives: To assess safety and effectiveness of not processing midstream urine (MSU) in adults to reduce asymptomatic bacteriuria (ASB) treatment, and find a biomarker that differentiates symptomatic urinary tract infection (SUTI) from ASB in adults. Methods: From 11/2013-04/2019 MSU for surgical/medical in-patients were routinely not processed. Patients were followed up for 4 and 30 days. Primary outcome was safety; secondary outcomes were antibiotic use, lab workload, and rate/proportion of MSU submitted/processed. A systematic review was conducted to identify potential biomarkers. Results: In 912 patients, no serious adverse events (AE) and 6 (0.66%) non-serious AE occurred due to not processing MSU. Processed MSU proportion, submitted MSU rate, and lab workload decreased (P=0.002; P=0.02; 5 person-days/year). Ninety-eight patients avoided antibiotics. Urine IL-6 and IL-8 were the most promising biomarkers. Conclusion: Not processing MSU reduces ASB treatment safely and effectively. Urine IL-6 and IL-8 could possibly differentiate ASB from SUTI.