Έχει νόημα να δίνουμε αντιβιoτικά στην ασυμπτωματική βακτηριουρία;

[Argirios Argiriou]

Σύμφωνα με τις Σουηδικές κατευθυντήριες οδηγίες δεν χρειάζεται να δίνουμε κάποια θεραπεία για την ασυμπτωματική βακτηριουρία.

Οι μόνες περιπτώσεις όπου έχει νόημα να κάνουμε έλεγχο για ασυμπτωματική βακτηριουρία είναι:
Α) Στην αρχή μιας εγκυμοσύνης.
Β) Μετά από θεραπεία ασυμπτωματικής βακτηριουρίας κατά την εγκυμοσύνη
Γ) Πριν από εγχείρηση TURP του προστάτη
Δ) Πριν από κάποια άλλη ουρολογική επέμβαση όπου υπάρχει κίνδυνος αιμορραγίας της βλεννογόνου.

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

[Argirios Argiriou]

Και οι Αμερικάνικες κατευθυντήριες οδηγίες είναι στο ίδιο μήκος κύματος με τις Σουηδικές:

15/09/2006

Asymptomatic Bacteriuria in Adults.

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[Argirios Argiriou]

12/08/2015

Treatment of Asymptomatic Bacteriuria Might Be Harmful.

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[Argirios Argiriou]

November 25, 2015

Treatment of Asymptomatic Bacteriuria Promotes Antibiotic Resistance

Neil M. Ampel, MD reviewing Cai T et al. Clin Infect Dis 2015 Dec 1. Wagenlehner FME and Naber KG. Clin Infect Dis 2015 Dec 1.

In an extension of a study of treatment for asymptomatic bacteriuria, recurrent bacteriuria and antibiotic resistance were more common in women who received antibiotics.

Antibiotic therapy for asymptomatic bacteriuria (AB; bacteria in urine without signs or symptoms of urinary tract infection) is recommended only for pregnant women and men undergoing urologic procedures; nonetheless, treatment of AB is common. A previous study demonstrated that women treated for AB had significantly higher rates of recurrent bacteriuria after 12 months compared with those not receiving antibiotics (NEJM JW Gen Med Nov 1 2012 and Clin Infect Dis 2012; 55:771). Now, in an extension of this study (mean follow-up, 39 months), the same Italian investigators analyzed the results from 550 participants (257 untreated; 293 treated with antibiotics).

Risk for recurrent bacteriuria was 4.4-fold higher in women who received antibiotics than in those who did not (P=0.003). Moreover, risk for developing recurrent bacteriuria with Escherichia coli resistant to amoxicillin/clavulanate (P=0.03), trimethoprim-sulfamethoxazole (P=0.01), and ciprofloxacin (P=0.03) was significantly higher in those who received antibiotics.

COMMENT

This study demonstrates the pernicious effect of antibiotic overuse. Not only did antibiotics fail to prevent recurrent bacteriuria, but they promoted resistance — even when their use occurred months or years before. As editorialists point out, this and other studies indicate that once antibiotic resistance develops, it has a low probability of reversal.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Neil M. Ampel, MD at time of publication
Leadership positions in professional societiesCoccidioidomycosis Study Group (President-Elect)

CITATION(S):

Cai T et al. Asymptomatic bacteriuria treatment is associated with a higher prevalence of antibiotic resistant strains in women with urinary tract infections. Clin Infect Dis 2015 Dec 1; 61:1655. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)
Abstract/FREE Full Text
Wagenlehner FME and Naber KG.Treatment of asymptomatic bacteriuria might be harmful. Clin Infect Dis 2015 Dec 1; 61:1662. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)
FREE Full Text
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[Argirios Argiriou]

April 17, 2019

Updated IDSA Guidelines for Managing Asymptomatic Bacteriuria
Jason T. McMullan, MD, MS, FAEMS reviewing Nicolle LE et al. Clin Infect Dis 2019 Mar 21

Screening for, or treating, asymptomatic bacteriuria is not recommended, except in pregnant patients.

Sponsoring Organization: Infectious Diseases Society of America (IDSA)

Background and Objective
Nontreatment of asymptomatic bacteriuria (ASB) is a priority in antimicrobial stewardship initiatives. This update to the 2005 IDSA guidelines incorporates new evidence and addresses additional populations, including children, patients with neutropenia, recipients of solid organ transplants, and patients undergoing nonurologic surgery.

Key Recommendations

Screening for, and then treating, asymptomatic bacteriuria is recommended for pregnant women; 4 to 7 days of antibiotics is recommended for pregnant women with ASB.

Screening and treatment is not recommended in the following populations: infants and children; healthy nonpregnant women of any age; elderly persons living independently or in a long-term care facility; patients with diabetes; renal transplant recipients >1 month after surgery; any nonrenal solid organ transplant recipients; patients with spinal cord injury; and patients with indwelling urinary catheters of any duration.

No recommendation is made for high-risk afebrile neutropenic patients due to lack of evidence.

Observation is preferred over antimicrobial treatment for cognitively impaired adults who experience a fall and are found to have bacteriuria without signs of infection.

COMMENT
These guidelines reinforce that the risks associated with treatment of asymptomatic bacteriuria generally outweigh the benefits, even in populations generally considered fragile. Notably, symptomatic patients are not covered by these recommendations.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Jason T. McMullan, MD, MS, FAEMS at time of publication
Consultant/Advisory Board   EMCREG International; Shire Pharmaceuticals
Grant/Research Support   NIH (Strategies to Innovate EmeRgENcy Care Clinical Trials Network; The ACCESS Trial); DoD (USAF; Intranasal Ketamine as an Adjunct to Fentanyl for the Prehospital Treatment of Acute Traumatic Pain; Pharmaceutical Degradation in Prehospital Deployment and in Extreme Temperature Simulation)
Editorial Boards   Journal of Emergency Medical Services
Leadership Positions in Professional Societies   NAEMSP (Chair, Research Committee)

CITATION(S):
Nicolle LE et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis 2019 Mar 21; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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