Abstract：
CONCLUSIONS: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
OBJECTIVE: Asymptomatic bacteriuria is often inappropriately treated, leading to antimicrobial-related adverse events and contributing to antimicrobial resistance. This study examined the asymptomatic bacteriuria treatment rate at a rural Wisconsin health system and the patient-specific factors that may be influencing clinicians\' decisions to treat.
METHODS: This is a retrospective descriptive report of patients admitted from January to May 2022 at 7 rural Wisconsin hospitals. Patients were included if they were a hospitalized adult with asymptomatic bacteriuria. Patients were excluded if they had a urinary tract abnormality, active infection, symptoms of a urinary tract infection, a planned urological surgery, or treatment or prophylaxis for a urinary tract infection within 72 hours of admission, were immunocompromised, or were transferred from an outside facility. Electronic and manual chart abstraction were used for data collection.
RESULTS: Of 429 patients with a positive urine culture, 137 patients with asymptomatic bacteriuria were included in the study. The median age was 75 years, and most patients were female (80.3%). The treatment rate of asymptomatic bacteriuria was 78.1%, amounting to 393 days of unnecessary antimicrobial therapy. Symptoms of fatigue (P = 0.014) and altered mentation (P < 0.006) and urinalysis results of nitrite positivity (P = 0.026) and pyuria (P < 0.001) were each independently associated with antimicrobial treatment.
CONCLUSIONS: Despite guideline recommendations to avoid treatment of asymptomatic bacteriuria, treatment rates in rural hospitalized patients remain high. Nonspecific signs and symptoms of altered mentation and fatigue as well as laboratory findings of nitrite positivity and pyuria were factors associated with a decision to treat. Future stewardship efforts should speak to the poor specificity of these factors.
OBJECTIVE: Asymptomatic bacteriuria is often inappropriately treated, leading to antimicrobial-related adverse events and contributing to antimicrobial resistance. This study examined the asymptomatic bacteriuria treatment rate at a rural Wisconsin health system and the patient-specific factors that may be influencing clinicians\' decisions to treat.
METHODS: This is a retrospective descriptive report of patients admitted from January to May 2022 at 7 rural Wisconsin hospitals. Patients were included if they were a hospitalized adult with asymptomatic bacteriuria. Patients were excluded if they had a urinary tract abnormality, active infection, symptoms of a urinary tract infection, a planned urological surgery, or treatment or prophylaxis for a urinary tract infection within 72 hours of admission, were immunocompromised, or were transferred from an outside facility. Electronic and manual chart abstraction were used for data collection.
RESULTS: Of 429 patients with a positive urine culture, 137 patients with asymptomatic bacteriuria were included in the study. The median age was 75 years, and most patients were female (80.3%). The treatment rate of asymptomatic bacteriuria was 78.1%, amounting to 393 days of unnecessary antimicrobial therapy. Symptoms of fatigue (P = 0.014) and altered mentation (P < 0.006) and urinalysis results of nitrite positivity (P = 0.026) and pyuria (P < 0.001) were each independently associated with antimicrobial treatment.
CONCLUSIONS: Despite guideline recommendations to avoid treatment of asymptomatic bacteriuria, treatment rates in rural hospitalized patients remain high. Nonspecific signs and symptoms of altered mentation and fatigue as well as laboratory findings of nitrite positivity and pyuria were factors associated with a decision to treat. Future stewardship efforts should speak to the poor specificity of these factors.
摘要：
结论：为了加快文章的发表，AJHP在接受后尽快在线发布手稿。接受的手稿经过同行评审和复制编辑，但在技术格式化和作者打样之前在线发布。这些手稿不是记录的最终版本，将在以后替换为最终文章（按照AJHP样式格式化并由作者证明）。
目的：无症状菌尿常被不当治疗，导致与抗菌药物相关的不良事件并导致抗菌药物耐药性。这项研究检查了威斯康星州农村卫生系统的无症状菌尿治疗率以及可能影响临床医生治疗决策的患者特异性因素。
方法：这是对2022年1月至5月在威斯康星州7家农村医院住院的患者的回顾性描述性报告。如果患者是无症状菌尿的住院成人，则将其包括在内。如果患者有尿路异常，将被排除在外，活动性感染,尿路感染的症状,计划中的泌尿外科手术,或在入院后72小时内治疗或预防尿路感染，免疫功能受损，或者是从外部设施转移过来的.电子和手动图表抽象用于数据收集。
结果：在429例尿培养阳性的患者中，137例无症状菌尿患者被纳入研究。中位年龄为75岁,大多数患者为女性（80.3%）。无症状菌尿的治疗率为78.1%,总计393天的不必要的抗菌治疗。疲劳症状（P=0.014）和情绪改变（P<0.006）以及亚硝酸盐阳性（P=0.026）和脓尿（P<0.001）的尿液分析结果均与抗菌治疗独立相关。
结论：尽管有指南建议避免治疗无症状性菌尿，农村住院患者的治疗率仍然很高。精神紊乱和疲劳的非特异性体征和症状以及亚硝酸盐阳性和脓尿的实验室发现是与决定治疗相关的因素。未来的管理工作应说明这些因素的特殊性较差。
目的：无症状菌尿常被不当治疗，导致与抗菌药物相关的不良事件并导致抗菌药物耐药性。这项研究检查了威斯康星州农村卫生系统的无症状菌尿治疗率以及可能影响临床医生治疗决策的患者特异性因素。
方法：这是对2022年1月至5月在威斯康星州7家农村医院住院的患者的回顾性描述性报告。如果患者是无症状菌尿的住院成人，则将其包括在内。如果患者有尿路异常，将被排除在外，活动性感染,尿路感染的症状,计划中的泌尿外科手术,或在入院后72小时内治疗或预防尿路感染，免疫功能受损，或者是从外部设施转移过来的.电子和手动图表抽象用于数据收集。
结果：在429例尿培养阳性的患者中，137例无症状菌尿患者被纳入研究。中位年龄为75岁,大多数患者为女性（80.3%）。无症状菌尿的治疗率为78.1%,总计393天的不必要的抗菌治疗。疲劳症状（P=0.014）和情绪改变（P<0.006）以及亚硝酸盐阳性（P=0.026）和脓尿（P<0.001）的尿液分析结果均与抗菌治疗独立相关。
结论：尽管有指南建议避免治疗无症状性菌尿，农村住院患者的治疗率仍然很高。精神紊乱和疲劳的非特异性体征和症状以及亚硝酸盐阳性和脓尿的实验室发现是与决定治疗相关的因素。未来的管理工作应说明这些因素的特殊性较差。
