JOURNAL READING

EFFECT OF INPATIENT ANTIBIOTIC TREATMENT

AMONG OLDER ADULTS WITH DELIRIUM FOUND
WITH A POSITIVE URINALYSIS: A HEALTH RECORD REVIEW

PEMBIMBING : dr. Krishna Adi Wibisana SpPD

CHIEF : dr. Jane Andrea
TAHAP 1 : dr. Muhamad Dwi Heriansyah
OUTLINE
 Introduction
 Summary of study
 Critical appraisal
 Validity
 Importance
 Applicability
 Conclusion
 INTRODUCTION

Joo P, Grant L, Ramsay T, Nitt C, Zvonar R, et al. ffect of inpatient antibiotic treatment among older adults with delirium found with a positive urinalysis: a health record review. BMC Geriatrics. 2022;22(916)
 INTRODUCTION

 Delirium is a common finding in older adult patients.

 Urinary Tract Infection (UTI) often suspected and treated with antibiotics, even in the
absence symptoms or signs.
 Asymptomatic Bacteriuria is also common in older adults.
 Studies recommend to look for other causes, rather than antibiotic treatment in
delirium with ASB population to avoid further harms.
 Despite those recommendation, treatment of antibiotic in delirium with ASB still a
common practice. Is there any benefit?

Joo P, Grant L, Ramsay T, Nitt C, Zvonar R, et al. ffect of inpatient antibiotic treatment among older adults with delirium found with a positive urinalysis: a health record review. BMC Geriatrics. 2022;22(916)
 SUMMARY OF STUDY - AIM

 Proportion of patients that treated with antibiotic in delirium patient with positive
urinalysis, between the patient with signs or symptoms and none.
 The assocation between antibiotic treatment and delirium resolutions, and adverse
outcomes.

Joo P, Grant L, Ramsay T, Nitt C, Zvonar R, et al. ffect of inpatient antibiotic treatment among older adults with delirium found with a positive urinalysis: a health record review. BMC Geriatrics. 2022;22(916)
 SUMMARY OF STUDY - METHOD

Design Observational, Retrospective cohort

Data source The Ottawa Hospital’s Data Warehouse
Participants Patients admitted to Ottawa Hospital from Januari 1 st to December 16th 2020.

Inclusion criteria Patients ≥65 years old.

Admitted from ED to either Family Medicine or General Internal Medicine.
Positive delirium screening within 36 hours of admission.
Positive urinalysis within 36 hours of admission.
Exclusion criteria Patients with indwelling urinary catheter including a suprapubic catheter, nephrostomy tube, or urologic
stent.
Patients with multiple admissoon included only once, on their first admission.
Primary outcome Proportion of patients that were treated with antibiotic
Secondary outcome Association between antibiotic and delirium resolutions
Association between antibiotic treatment and adverse outcomes

Joo P, Grant L, Ramsay T, Nitt C, Zvonar R, et al. ffect of inpatient antibiotic treatment among older adults with delirium found with a positive urinalysis: a health record review. BMC Geriatrics. 2022;22(916)
Na Y, Kim SW, Park IB, Choi SJ, Nam S, Jung J, et al. Association Between DPP4 Inhibitor Use and the Incidence of Cirrhosis, ESRD, and Some Cancers in Patients With Diabetes. J. Clin. Endocrinol. Metab. 2022;107(11)

Results
SUMMARY OF STUDY
SUMMARY OF STUDY

Joo P, Grant L, Ramsay T, Nitt C, Zvonar R, et al. ffect of inpatient antibiotic treatment among older adults with delirium found with a positive urinalysis: a health record review. BMC Geriatrics. 2022;22(916)
SUMMARY OF STUDY

Joo P, Grant L, Ramsay T, Nitt C, Zvonar R, et al. ffect of inpatient antibiotic treatment among older adults with delirium found with a positive urinalysis: a health record review. BMC Geriatrics. 2022;22(916)
 SUMMARY OF STUDY - DISCUSSION

 Majority of patients with delirium and positive urinalysis were treated with antibiotics
 2/3 patients with ASB still given antibiotic treatment.
 Demographic background number of comorbidities may be factors in antibiotic
treatment.
 There are no diffrence in delirium resolutions on 7th day of admission between those
treated with antibiotic and not in ASB population.
 Only 20% of total population had Positive Culture for UTI.
 Clinician should assess for other causes when faced with this population.

Joo P, Grant L, Ramsay T, Nitt C, Zvonar R, et al. ffect of inpatient antibiotic treatment among older adults with delirium found with a positive urinalysis: a health record review. BMC Geriatrics. 2022;22(916)
 SUMMARY OF STUDY - DISCUSSION

This finding is consistent with previous studies, there are no proven benefits treating
ASB with antibiotics.

However, it is difficult to make firm conlusion given the obvious number difference
between the two groups.

Joo P, Grant L, Ramsay T, Nitt C, Zvonar R, et al. ffect of inpatient antibiotic treatment among older adults with delirium found with a positive urinalysis: a health record review. BMC Geriatrics. 2022;22(916)
 SUMMARY OF STUDY - LIMITATIONS

 Given the nature of retrospective health record review, some signs and symptoms are not properly
documented.
 Heterogeneity and small size of sample population

Joo P, Grant L, Ramsay T, Nitt C, Zvonar R, et al. ffect of inpatient antibiotic treatment among older adults with delirium found with a positive urinalysis: a health record review. BMC Geriatrics. 2022;22(916)
CRITICAL APPRAISAL
CEBM: PROGNOSTIC STUDIES WORKSHEET
PICO

Patient: Patients aged ≥ 65, with positive delirium

screening and urinalysis

Intervention: Antibiotic Treatments

Control: No Antibiotic Treatment

Outcome: Delirium resolutions in 7th day, adverse

outcome
VALIDITY
 Was the defined representative sample of patients assembled at a common (usually early) point in the course of
their disease?
 Not Sure

All participants are patients aged 65, with positive

urinalysis and positive delirium assessment in the first 36
hours of admission.
This method overlooked patient's comorbidities and the
chronicity of the disease.
VALIDITY
 Was patient follow-up sufficiently long and complete?
 Not Sure

Durations of study solely based on survey.

All participants complete the study.
VALIDITY
 Were outcome criteria either objective or applied in a ‘blind’ fashion?
 Yes

Three researchers independently extracted the data, and

any disagreement resolve with consensus.
IMPORTANT
 How likely are the outcomes over time?
 How precise are the prognostic estimates?
 Not Sure

There are no significant differences in results between the two groups in terms of delirium resolutions, and adverse
outcomes.
Given the nature of the study was a descriptive study, no formal hypotheses were conducted, and no p-values are
provided, we can't make a firm judgement.
SUMMARY OF STUDY

Joo P, Grant L, Ramsay T, Nitt C, Zvonar R, et al. ffect of inpatient antibiotic treatment among older adults with delirium found with a positive urinalysis: a health record review. BMC Geriatrics. 2022;22(916)
IMPORTANT
 Can I apply this valid, important evidence about prognosis to my patient?
 Yes

The study was conducted in academic tertiary care system.

So there a similarity of patients population.
CONCLUSION

Validity Valid
Importance Statistically Insignificant Results
Applicability Applicable

 There are no evidence antibiotic treatment associated with faster delirium resolutions, and adverse
outcome such as mortality or ICU admission.
 There is a lack of participants in the study.
 A larger RCT are needed to further examine whether antibiotic treatment in older adults with delirium
and positive urinalysis has an impact on delirium resolution, especially among those who have no
other symptoms or indications for antibiotics
THANK YOU