DUGi

Effects of antibiotic treatment for Asymptomatic Bacteriuria in elderly patients with Acute confusional syndrome: avoiding mistreatment of Urinary tract infection. A multicentre, consecutive and conglomerated controlled clinical trial

http://dugi.udg.edu/item/http:@@@@hdl.handle.net@@10256@@28471

Delirium, also known as acute confusional syndrome (ACS), is a common and serious condition among older adults, especially those attending emergency departments. It is characterised by an acute and fluctuating disturbance in attention, awareness, and cognition, and is often triggered by underlying medical conditions, medications, or environmental factors. Despite its clinical relevance, delirium is often misdiagnosed or attributed to other causes, particularly infections. One of the most common diagnostic and therapeutic challenges in this context is differentiating a true urinary tract infection (UTI) from asymptomatic bacteriuria (ASB). ASB, which is defined as the presence of bacteria in the urine without urinary symptoms, is highly prevalent in elderly populations, particularly among institutionalised patients and those with comorbidities or functional dependence. However, the mere detection of bacteriuria in the absence of urinary symptoms or systemic signs of infection does not imply an UTI that requires antibiotic therapy, as recommended by current clinical guidelines. Nevertheless, antibiotic overuse in this population remains common in clinical practice and a significant proportion of elderly patients with delirium and bacteriuria are prescribed antibiotics despite not meeting the diagnostic criteria for a UTI. Consequently, inappropriate antibiotic use contributes to the emergence of multidrug-resistant organisms, increases the risk of adverse drug reaction and may worsen clinical outcomes by delaying identification and treatment of the underlying cause of delirium. Despite these concerns, evidence on the impact of antibiotic treatment for asymptomatic bacteriuria (ASB) in elderly patients presenting with delirium remains limited and inconsistent. The present study seeks to address this knowledge gap and aims to determine whether antibiotic treatment provides measurable benefits or merely contributes to overtreatment. The findings could inform future guidelines and optimise the management of delirium in older adults, promoting rational, evidence-based antibiotic use in clinical practice. Design and participants: Multicentre, prospective, cluster randomised (hospitals), open-label parallel-group clinical trial, in which data managers will be blinded to group assignment and independent of the intervention

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