Project Presentation Kate McCollough Jennifer Dulin FuNdAmentals of Epidemiology I December 3 2019 Study Question Question Does antibiotic treatment of ASB decrease the incidence of discharge to a facility for hospitalized patients aged 70 or older admitted from home with a positive de ID: 775180
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Slide1
Asymptomatic bacteriuria, Antibiotics and Delirium:Project Presentation
Kate McCollough
Jennifer
Dulin
FuNdAmentals
of Epidemiology I
December 3, 2019
Slide2Study Question
Question:
Does antibiotic treatment of ASB decrease the incidence of discharge to a facility for hospitalized patients aged 70 or older admitted from home with a positive delirium screen (
bCAM
)?
Hypothesis:
Antibiotic treatment increases incidence of discharge to a facility in the study population
Slide3Exposure
Exposure:
Antibiotic treatment of asymptomatic bacteriuria (ASB)
ASB: positive urine culture with ≥10
5
colony-forming units (CFU)/mL of organism without signs/symptoms attributable to UTI
ASB occurs in up to 20% of elderly
Delirium: acutely altered mental status characterized by inattentions, disturbed cognition, altered LOC, fluctuating course
Delirium: up to 50% of hospitalized elderly
bCAM
(brief Cognitive Assessment Method), validated screening tool with 85%
sn
, 95%
sp
Up to 82.7% of elderly with ASB receive inappropriate antibiotics
IDSA recommends NOT treating ASB in elderly with confusion for 24-48h while work-up for delirium is underway
Slide4Outcome
Outcome:
Increased discharge to a facility
Discharge to a facility is a marker of decreased functional status, increased morbidity
Institutionalization signals a cascade of loss of independence, increased morbidity and mortality and health care costs
Increases likelihood of rehospitalization
30-40% of delirium may be preventable, work-up often stops with identification of bacteriuria, allowing underlying cause to perpetuate and outcomes to worsen
Slide5Slide6Analysis
Exposure: Antibiotic treatment for ASB, dichotomous
Outcome: Discharge to a facility, categorical
Test for binomial proportions; two-sided test
Measure of Association: Risk Ratio
Covariates: age, gender, race, CCI, Urinary catheter presence, opioid and anticholinergic administration, dementia, leukocytosis
Sample Size: 740 (Kelsey)
Proportion exposed 67%
Risk Unexposed: 52%
Risk Ratio: 1.2
Slide7Limitations
Retrospective design
Selection bias
No blinding
Single center design (academic, tertiary care)
Incomplete data (medical records)
Delirium
Clinical diagnosis
Presence, not duration
Marker of more severe illness (i.e. effect modification)
Antibiotic treatment
Indication
Timing
Lack of documentation pre-existing:
Dementia
Functional status
Delirium Risk Factors
Disposition
Affected by delirium treatment?
Reason other than delirium?