Physicians tend to Over-Treat Bacteria in Urine

urine microscopy
In a new study published in the Archives of Internal Medicine, researchers from Michael E. DeBakey Veterans Affairs Medical Center and the MD Anderson Cancer Center have found that most of the physicians prescribe antibiotics whenever they see a positive urine culture. They do so, in the absence of any signs or symptoms of urinary tract infection, which is against the guidelines prescribed by the Infectious Diseases Society of America.
The researchers, led by Dr. Eugene Lin, carried out the study with the purpose of analyzing whether the management practice in clinical scenarios conform to the Infectious Diseases Society guidelines. The researchers examined the records of 339 patients whose urine cultures tested positive for Enterococcus. Of these patients, 54% met the criteria of asymptomatic bacteriuria whereas 46% had urinary tract infection. It was seen that the treating physicians prescribed antibiotics for 32.8% of patients with asymptomatic bacteriuria. It was also noticed that in most of these cases, patients had presented with pyuria.
According to the guidelines meant for treating urinary tract infection, antibiotics should not be prescribed in the absence of symptoms, as most of these infections resolve on their own. Prescribing antibiotics in such cases only increases the risk of developing resistance to the antibiotic. The guidelines justify the use of antibiotics for treating urinary bacteria even in the absence of any symptoms only in the case of pregnant women. However, most of the physicians prescribe antibiotics as they are afraid that the asymptomatic bacteriuria, if left untreated, may lead to some dangerous infection later on.
According to the researchers, hospital patients who are catheterized are most likely to develop bacteria in the urine. However, this bacteriuria clears on its own, without resorting to any antibiotic, within a week of the removal of the catheter. As prescribing of antibiotics is a matter of clinical judgment, educating the patients can go a long way in preventing this menace. The patients must be educated that not all bacteria in the urine can lead to urinary tract infection. Hence, it is worthwhile to wait for the development of symptoms before resorting to antibiotics.
Wednesday, September 1, 2010
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