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Antimicrobial therapy for asymptomatic bacteriuria or candiduria in advanced cancer patients transitioning to comfort measures

Published online by Cambridge University Press:  01 March 2019

Rupak Datta*
Affiliation:
Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut
Tianyun Wang
Affiliation:
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
Mojun Zhu
Affiliation:
Department of Hematology and Oncology, Mayo Clinic, Rochester, Minnesota
Louise Marie Dembry
Affiliation:
Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
Ling Han
Affiliation:
Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut
Heather Allore
Affiliation:
Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
Vincent Quagliarello
Affiliation:
Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut
Manisha Juthani-Mehta
Affiliation:
Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
*
Author for correspondence: Rupak Datta, Email: [email protected]

Abstract

Among 300 advanced cancer patients with potential urinary tract infection (UTI), 19 had symptomatic UTI. Among remaining patients (n = 281), 21% had asymptomatic bacteriuria or candiduria, and 14% received inappropriate therapy for 279 antimicrobial days. Bacteriuria or candiduria predicted antimicrobial therapy. At 10,000 to <100,000 CFU/mL, the incidence rate ratio [IRR] was 16.9 (95% confidence interval [CI], 6.0–47.2), and at ≥100,000 CFU/mL, the IRR was 27.9 (95% CI, 10.9–71.2).

Type
Concise Communication
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

a

Authors of equal contribution.

PREVIOUS PRESENTATION: This work was presented in part in the session on Antimicrobial Stewardship: Special Populations (presentation #248) at IDWeek 2018, on October 4, 2018, in San Francisco, California.

References

Thompson, AJ, Silveira, MJ, Vitale, CA, Malani, PN. Antimicrobial use at the end of life among hospitalized patients with advanced cancer. Am J Hospice Palliat Care 2012;29:599603.CrossRefGoogle ScholarPubMed
White, PH, Kuhlenschmidt, HL, Vancura, BG, Navari, RM. Antimicrobial use in patients with advanced cancer receiving hospice care. J Pain Symptom Manag 2003;25:438443.CrossRefGoogle ScholarPubMed
Reinbolt, RE, Shenk, AM, White, PH, Navari, RM. Symptomatic treatment of infections in patients with advanced cancer receiving hospice care. J Pain Symptom Manag 2005;30:175182.CrossRefGoogle ScholarPubMed
Datta, R, Juthani-Mehta, M. Burden and management of multidrug-resistant organisms in palliative care. Palliat Care 2017;10:16. doi: 10.1177/1178224217749233.Google ScholarPubMed
Trautner, BW, Grigoryan, L, Petersen, NJ, et al. Effectiveness of an antimicrobial stewardship approach for urinary catheter–associated asymptomatic bacteriuria. JAMA Intern Med 2015;175:11201127.CrossRefGoogle ScholarPubMed
Nace, DA, Drinka, PJ, Crnich, CJ. Clinical uncertainties in the approach to long term care residents with possible urinary tract infection. J Am Med Dir Asso 2014;15:133139.CrossRefGoogle Scholar
Urinary tract infection and other urinary system events. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/7psccauticurrent.pdf. Published 2018. Accessed January 27, 2019.Google Scholar
Deshpande, A, Pasupuleti, V, Thota, P, et al. Community-associated Clostridium difficile infection and antibiotics: a meta-analysis. J Antimicrob Chemother 2013;68:19511961.CrossRefGoogle ScholarPubMed
Silver, SA, Baillie, L, Simor, AE. Positive urine cultures: a major cause of inappropriate antimicrobial use in hospitals? Can J Infect Dis Med Microbiol 2009;20(4):107111.CrossRefGoogle Scholar
Nicolle, LE, Bradley, S, Colgan, R, Rice, JC, Schaeffer, A, Hooton, TM. Infectious diseases society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643654.CrossRefGoogle Scholar