Table 2.
Bivariate Analysis of Hospitalized Patients Presenting to the Emergency Department Ultimately Diagnosed With Asymptomatic Bacteriuria and Treated With Antibiotics by Emergency Medicine Clinicians Versus Never Treated With Antibiotics, N = 1884
| Variable | Antibiotic Treatment by EM (n = 1253) | No Antibiotics (n = 631) | Odds Ratio (95% CI) | P Valuea |
|---|---|---|---|---|
| Baseline Characteristics | ||||
| Age (median, IQR) | 80 (69–87) | 75 (62–85) | 1.02 (1.01–1.03) | <.0001 |
| Gender (female) | 911 (72.7%) | 471 (74.6%) | 0.99 (0.78–1.25) | .92 |
| Race (white) | 921 (74.0%) | 495 (78.6%) | 0.95 (0.79–1.13) | .54 |
| Charlson comorbidity index,0 | 132 (10.5%) | 84 (13.3%) | REF | .16 |
| 1–2 | 407 (32.5%) | 200 (31.7%) | 1.28 (0.91–1.79) | |
| 3–4 | 396 (31.6%) | 175 (27.7%) | 1.42 (1.04–1.94) | |
| ≥5 | 318 (25.4%) | 172 (27.3%) | 1.27 (0.96–1.67) | |
| Diabetes | 452 (36.1%) | 250 (39.6%) | 0.89 (0.73–1.10) | .29 |
| Moderate or severe chronic kidney disease | 520 (41.5%) | 247 (39.1%) | 1.24 (0.96–1.61) | .10 |
| History of cancer | 261 (20.8%) | 132 (20.9%) | 1.04 (0.85–1.28) | .68 |
| Spinal cord injury | 35 (02.8%) | 3 (0.5%) | 5.17 (1.42–18.77) | .01 |
| Dementia | 384 (30.6%) | 87 (13.8%) | 2.27 (1.83–2.83) | <.0001 |
| Immunosuppressedb | 37 (03.0%) | 18 (2.9%) | 1.24 (0.61–2.52) | .55 |
| IV chemotherapy in preceding 30 days | 10 (00.8%) | 6 (1.0%) | 0.96 (0.20–4.58) | .96 |
| Hemodialysis | 20 (01.6%) | 9 (1.4%) | 0.84 (0.51–1.37) | .48 |
| Transfer from postacute carec | 88 (07.0%) | 27 (4.3%) | 1.74 (1.27–2.39) | .0006 |
| Nonambulatory | 224 (17.9%) | 55 (8.7%) | 1.92 (1.46–2.53) | <.0001 |
| Hospitalization in past 90 days | 373 (29.8%) | 195 (30.9%) | 0.92 (0.76–1.10) | .34 |
| Antibiotics in preceding 90 days | 263 (21.0%) | 92 (14.6%) | 1.31 (1.06–1.62) | .011 |
| Indwelling catheter | 215 (17.2%) | 58 (9.2%) | 1.55 (1.21–1.98) | .0006 |
| Any urinary catheterd | 249 (19.9%) | 68 (10.8%) | 1.55 (1.22–1.96) | .0003 |
| Signs and Symptoms | ||||
| Abdominal pain | 248 (19.8%) | 158 (25.0%) | 0.88 (0.73–1.05) | .16 |
| Incontinence | 445 (35.5%) | 138 (21.9%) | 2.20 (1.80–2.68) | <.0001 |
| Functional decline | 93 (07.4%) | 28 (04.4%) | 1.79 (0.88–3.64) | .11 |
| Acutely altered mental status | 393 (31.4%) | 86 (13.6%) | 2.51 (2.02–3.13) | <.0001 |
| Fatigue, malaise, lethargy | 396 (31.6%) | 175 (27.7%) | 1.53 (1.16–2.01) | .003 |
| Nausea or vomiting | 267 (21.3%) | 179 (28.4%) | 0.88 (0.69–1.13) | .33 |
| Change in color, sediment, or malodorous urine | 202 (16.1%) | 71 (11.3%) | 1.93 (1.23–3.03) | .004 |
| Urinary retention or postvoid residual > 200 cc | 143 (11.4%) | 54 (08.6%) | 1.34 (0.96–1.88) | .08 |
| Severity of Illness | ||||
| qSOFAe (≥2 vs <2) | 152 (12.1%) | 65 (10.3%) | 1.33 (1.06–1.68) | .01 |
| ≥ 2 SIRSf criteria | 300 (23.9%) | 191 (30.3%) | 0.80 (0.66–0.97) | .02 |
| Laboratory Results | ||||
| Peripheral leukocytosisg | 356 (28.4%) | 186 (29.5%) | 1.01 (0.87–1.16) | .93 |
| Abnormal urinalysish | 1232 (98.3%) | 528 (83.7%) | 9.42 (5.30–16.75) | <.0001 |
| Hospital Characteristics | ||||
| Type of control | ||||
| Not-for-profit | 1141 (91.1%) | 606 (96.0%) | REF | .04 |
| For profit | 112 (8.9%) | 25 (4.0%) | 2.57 (1.03–6.40) | |
| Bed size (10 bed increase) | 327 (203–443) | 310 (189–443) | 1.01 (0.99–1.01) | .62 |
| Teaching hospital | 1165 (93.0%) | 555 (88.0%) | 1.19 (0.59–2.40) | .62 |
Abbreviations: CI, confidence interval; EM, emergency medicine clinician; IQR, interquartile range; IV, intravenous; qSOFA, quick sequential organ failure assessment; REF, Reference; SIRS, systemic inflammatory response syndrome.
a P < .05 is considered significant.
bDefined as chemotherapy administered within 30 days, human immunodeficiency virus with CD4 >200, ≥10 mg/day prednisone for at least 30 days (or equivalent steroid dose), on biologic agents such as tumor necrosis factor inhibitors or other immunosuppressant agents, congenital or acquired immunodeficiency.
cIncludes transfer from the following: subacute rehabilitation center, skilled nursing home, acute rehabilitation center, assisted living, other hospital. Also includes if patient had been admitted or resided in a nursing home, subacute rehabilitation center, or extended care facility in the prior 30 days.
dIncludes Foley catheter, intermittent straight catheterization, and suprapubic catheter present on day of urine culture collection or 1 day before urine culture collection.
eQuick SOFA score: systolic blood pressure ≤100 mmHg = 1, respiratory rate ≥22 breaths per minute = 1; Glasgow coma score <15 = 1.
fSIRS (temperature <36°C [96.8°F] or > 38.0°C [100.4°F], heart rate >90 beats per minute, respiratory rate >20 breaths per minute, white blood cell count <4000/mm3 or >12 000/mm3).
gDefined as white blood cell count >10 per high-power field.
hDefined as presence of leukocyte esterase or nitrite, or white blood cells >5 per high-power field.