Clinical question: Does treating asymptomatic bacteriuria (AB) cause harm in women?
Background: In women with recurrent UTIs, AB is often treated, increasing the risk of multi-drug-resistant bacteria. At the same time, little data exist on the relationship between AB treatment and risk of higher antibiotic resistance in women with recurrent UTIs.
Study design: Follow-up observational, analytical, longitudinal study on a previously randomized clinical trial (RCT).
Setting: Sexually transmitted disease (STD) center in Florence, Italy.
Synopsis: Using the patients from the authors’ previous RCT, the study followed 550 women with recurrent UTIs and AB for a mean of 38.8 months in parallel groups: One group had AB treated, and the other group did not. In the group of women treated with antibiotics, the recurrence rate was 69.6% versus 37.7% in the group not treated (P<0.001). In addition, E. coli isolates showed more resistance to amoxicillin/clavulanic acid (P=0.03), trimethoprim/sulfamethazole (P=0.01), and ciprofloxacin (P=0.03) in the group previously treated with antibiotics.
Given the observational design of the study, data must be interpreted with caution in determining a causal relationship. However, prior studies have shown this relationship, and current Infectious Diseases Society of America guidelines support neither screening nor treating AB.
Bottom line: In women with recurrent UTIs, previous treatment of AB is associated with higher rates of antibiotic-resistant bacteria, causing symptomatic UTIs.
Citation: Cai T, Nsei G, Mazzoli S, et al. Asymptomatic bacteriuria treatment is associated with a higher prevalence of antibiotic resistant strains in women with urinary tract infection. Clin Infect Dis. 2015;61(11):1655-1661.
National Healthcare Spending Increased in 2014
Led by expansions under the Affordable Care Act, healthcare spending increased 5.3% from the previous year and now totals $3 trillion, which represents 17.5% of the gross domestic product.
Citation: Martin AB, Hartman M, Benson J, Catlin A. National health spending in 2014: faster growth drive by coverage expansion and prescription drug spending. Health Aff. 2016;35(1):150-160.