Abstract：
Among older adults with delirium and positive urinalysis, antibiotic treatment for urinary tract infection is common practice, but unsupported by literature or guidelines. We sought to: i) determine the rate of antibiotic treatment and the proportion of asymptomatic patients (other than delirium) in this patient population, and ii) examine the effect of antibiotic treatment on delirium resolution and adverse outcomes.
A health record review was conducted at a tertiary academic centre from January to December 2020. Inclusion criteria were age ≥ 65, positive delirium screening assessment, positive urinalysis, and admission to general medical units. Outcomes included rates of antibiotic treatment, delirium on day 7 of admission, and 30-day adverse outcomes. We compared delirium and adverse outcome rates in antibiotic-treated vs. non-treated groups. We conducted subgroup analyses among asymptomatic patients.
We included 150 patients (57% female, mean age 85.4 years). Antibiotics were given to 86%. The asymptomatic subgroup (delirium without urinary symptoms or fever) comprised 38% and antibiotic treatment rate in this subgroup was 68%. There was no significant difference in delirium rate on day 7 between antibiotic-treated vs. non-treated groups, (entire cohort RR 0.94 [0.41-2.16] and asymptomatic subgroup RR 0.69 [0.22-2.15]) or in 30-day adverse outcomes.
Older adults with delirium and positive urinalysis in general medical inpatient units were frequently treated with antibiotics - often despite the absence of urinary or other infectious symptoms. We failed to find evidence that antibiotic treatment in this population is associated with delirium resolution on day 7 of admission.
A health record review was conducted at a tertiary academic centre from January to December 2020. Inclusion criteria were age ≥ 65, positive delirium screening assessment, positive urinalysis, and admission to general medical units. Outcomes included rates of antibiotic treatment, delirium on day 7 of admission, and 30-day adverse outcomes. We compared delirium and adverse outcome rates in antibiotic-treated vs. non-treated groups. We conducted subgroup analyses among asymptomatic patients.
We included 150 patients (57% female, mean age 85.4 years). Antibiotics were given to 86%. The asymptomatic subgroup (delirium without urinary symptoms or fever) comprised 38% and antibiotic treatment rate in this subgroup was 68%. There was no significant difference in delirium rate on day 7 between antibiotic-treated vs. non-treated groups, (entire cohort RR 0.94 [0.41-2.16] and asymptomatic subgroup RR 0.69 [0.22-2.15]) or in 30-day adverse outcomes.
Older adults with delirium and positive urinalysis in general medical inpatient units were frequently treated with antibiotics - often despite the absence of urinary or other infectious symptoms. We failed to find evidence that antibiotic treatment in this population is associated with delirium resolution on day 7 of admission.
摘要：
在患有谵妄和尿液分析阳性的老年人中，抗生素治疗尿路感染是常见的做法，但没有文献或指南的支持。我们试图：i）确定该患者人群中抗生素治疗的比率和无症状患者（谵妄除外）的比例，和ii）检查抗生素治疗对谵妄消退和不良结局的影响。
2020年1月至12月，在一个三级学术中心进行了健康记录审查。纳入标准为年龄≥65岁，谵妄筛查评估阳性，尿液分析阳性,进入普通医疗单位。结果包括抗生素治疗的比率，入院第7天谵妄，和30天的不良结果。我们比较了抗生素治疗的谵妄和不良结局率与非治疗组。我们在无症状患者中进行了亚组分析。
我们纳入了150名患者（57%为女性，平均年龄85.4岁)。抗生素的比例为86%。无症状亚组（无泌尿系症状或发热的谵妄）占38％，该亚组的抗生素治疗率为68％。抗生素治疗与抗生素治疗的第7天的谵妄率没有显着差异。非治疗组，（整个队列RR0.94[0.41-2.16]和无症状亚组RR0.69[0.22-2.15]）或30天不良结局。
在普通内科住院病房中，患有谵妄和尿液分析阳性的老年人经常使用抗生素治疗-通常尽管没有泌尿或其他感染症状。我们没有发现证据表明该人群的抗生素治疗与入院第7天的谵妄消退有关。
2020年1月至12月，在一个三级学术中心进行了健康记录审查。纳入标准为年龄≥65岁，谵妄筛查评估阳性，尿液分析阳性,进入普通医疗单位。结果包括抗生素治疗的比率，入院第7天谵妄，和30天的不良结果。我们比较了抗生素治疗的谵妄和不良结局率与非治疗组。我们在无症状患者中进行了亚组分析。
我们纳入了150名患者（57%为女性，平均年龄85.4岁)。抗生素的比例为86%。无症状亚组（无泌尿系症状或发热的谵妄）占38％，该亚组的抗生素治疗率为68％。抗生素治疗与抗生素治疗的第7天的谵妄率没有显着差异。非治疗组，（整个队列RR0.94[0.41-2.16]和无症状亚组RR0.69[0.22-2.15]）或30天不良结局。
在普通内科住院病房中，患有谵妄和尿液分析阳性的老年人经常使用抗生素治疗-通常尽管没有泌尿或其他感染症状。我们没有发现证据表明该人群的抗生素治疗与入院第7天的谵妄消退有关。
