A study of four Veterans Affairs (VA) hospitals found that almost a third of urinary tract infection (UTI) diagnoses are inappropriate in patients with neurogenic bladder (NB), researchers reported late last week in Antimicrobial Stewardship & Healthcare Epidemiology.
For the retrospective study, VA researchers analyzed data on veterans with NB—the name given to a number of urinary conditions in patients who lack bladder control because of a brain or spinal cord injury—who were hospitalized with a UTI or asymptomatic bacteriuria (ASB) diagnosis from Jan 1, 2017, to Dec 31, 2018. Many NB patients require urinary catheters, which have been linked to chronic bacteriuria and UTIs. While ASB is commonly mistaken for UTI and treated inappropriately with antibiotics, no studies have looked specifically at patients with NB and suspected UTI, the authors said.
Each patient was evaluated for appropriateness of diagnosis based on national guidelines, with researchers comparing outcomes in those who received appropriate and inappropriate diagnosis and treatment.
The study included 170 encounters with ASB (30%) or UTI (70%) occurring in 166 patients (86% males). While all ASB diagnoses were appropriate, and 96.1% had appropriate treatment, 31.1% of UTI had inappropriate diagnoses and 51.3% received inappropriate treatment. Among patients with spinal cord injury/disorder (SCI/D) or multiple sclerosis, appropriate diagnosis and treatment was associated with significantly longer post-culture hospital stays (median, 14 vs 7 days), but no other outcomes were significantly associated with appropriate versus inappropriate ASB or UTI diagnosis or treatment.
"Our study provides further support for implementing diagnostic stewardship interventions, specifically targeting hospitalized patients with NB," the study authors wrote, adding that stewardship interventions should prioritize settings such as inpatient rehabilitation, long-term care facilities, and SCI/D units.