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BACTERIURIA (ASYMPTOMATIC, IN ELDERLY WOMEN) PROBABLY DOESN’T BENEFIT FROM TREATMENT.

Clinical Bottom Line(s):
It probably isn’t worthwhile to treat asymptomatic bacteriuria in elderly women (no clear mortality benefit, plus the side-effects of Rx).

Appraiser: Sackett, 6 April 1995

The Evidence:

  1. an RCT (av. follow-up about 3 years) of short-course antimicrobials (with relapses/ recurrentces treated also, and 83% cured) vs. no therapy or placebo (with 16% cleared) in 358 elderly (mean age 81) ambulatory women in retirement communities in Pennsylvania USA.

  2. an RCT (av follow-up 1 year) of single, 1-week or 6-week antimicrobials (with relapses/ recurrences treated also, but only about 40% cured) vs. no therapy (with about 15% cured) in 50 elderly (mean age 83) institutionalized women in Alberta, Canada.

endpoints

Control

 

Treated

RRR

ARR

NNT

[1] deaths during follow-up (av about 3 years)

.203

(39/192)

.181

(30/166)

11% but 95% CI crosses zero

0.02, but 95% CI crosses zero

goes to infinity

[2] deaths during follow-up (average about 1 year)

.182

(4/22)

.391

(9/23)

115% increased risk of death

(p=0.11)

    

Comments:

  1. Crude summing of the two trials gives virtually identical death rates, and doesn’t exclude either benefit (NNT to save a life = 13) or harm (NNH to take a life = 13). Need lots more trial evidence.
  2. In the meanwhile, also have to consider cost, hassle, and side-effects of searching for and treating asymptomatic bacteriuria.

REFERENCES:

  1. Abrutyn E, Mossey J, Berlin JA, Bosica J, Levison M, Pitsakis P, Kaye D: Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women? Ann Intern Med 1994;120:827-33.
  2. Nicolle LE, Mayhew WJ, Bryan L: Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. Am J Med 1987;83:27-33.

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