Management of Asymptomatic Bacteriuria and Urinary Tract Infections in Patients With Neurogenic Bladder and Factors Associated With Inappropriate Diagnosis and Treatment

Arch Phys Med Rehabil, 2024 · DOI: 10.1016/j.apmr.2023.09.023 · Published: January 1, 2024

Simple Explanation

This study examined how asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) are managed in patients with neurogenic bladder (NB). Inappropriate diagnosis and treatment of these conditions are a leading cause of antibiotic overuse. The study found that a large proportion of UTI encounters in patients with NB are managed inappropriately, often due to misdiagnosing ASB as UTI. This leads to unnecessary antibiotic use. The researchers suggest that interventions to improve ASB and UTI management should focus on educating providers and targeting complex patients with comorbidities.

Study Duration

2 Years

Participants

291 unique patients (300 encounters)

Evidence Level

Retrospective cohort study

Key Findings

1
Nearly all ASB encounters had appropriate diagnosis (98%).
2
70 (35%) UTI encounters had inappropriate diagnosis, including 55 (27.5%) with true ASB, all with inappropriate treatment.
3
Peripheral vascular disease, chronic kidney disease, and cerebrovascular disease were associated with increased odds of inappropriate management.

Research Summary

This multicenter study evaluated the appropriateness of ASB and UTI management in patients with NB. It identified factors associated with inappropriate diagnosis and treatment to improve the quality of UTI-related care in this population. The study found that a significant proportion of UTI encounters were managed inappropriately, largely due to misdiagnosis of ASB as UTI, which can lead to unnecessary antibiotic use. The research suggests targeted interventions focusing on provider education, accurate diagnosis, and guideline-based treatment to improve ASB and UTI management in patients with NB, especially those with comorbidities.

Practical Implications

Improve Provider Education

Educate healthcare providers on differentiating between ASB and UTI, emphasizing the importance of symptom-based diagnosis and appropriate antibiotic use.

Implement Diagnostic Stewardship

Introduce diagnostic stewardship interventions to reduce unnecessary urine cultures in asymptomatic patients, potentially requiring documentation of signs or symptoms before ordering a culture.

Target High-Risk Patients

Focus interventions on patients with comorbidities like peripheral vascular disease, chronic kidney disease, and cerebrovascular disease, as they are at higher risk of inappropriate management.

Study Limitations

1
The study was conducted using VA data, which may not be representative of patients with NB outside the VA system.
2
Definitions for MS, PD, NB, and UTI were primarily based on ICD-10-CM codes, which may not accurately reflect true proportions due to coding inaccuracies.
3
Data were dependent on medical record review and limited by documentation in provider notes and other sources in the VA electronic health record.

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