Confusion strongly associated with antibiotic prescribing due to suspected urinary tract infections in nursing homes

Objectives: To quantify the prevalence of documented urinary tract infection (UTI), nonspecific symptoms, and antibiotic treatment of suspected UTI in nursing homes (NHs) in the tropics and to describe the typical resident likely to receive antibiotic treatment for suspected UTI and factors associated with the development of confusion, fatigue, and restlessness. Design: Cross-sectional. Setting: Five far north Queensland NHs in tropical Australia. Participants: NH residents (N=450). Measurements: Chartreviews of NH residents between August 28, 2015, and June 21, 2016, to determine the prevalence of documented UTI, new or worsening nonspecific and specific symptoms that are specific or nonspecific to the urinary tract, antibiotic use, medical conditions, and medication factors. Results: UTI accounted for 33% of all current infections treated with antibiotics and 40% of all infections treated with antibiotics within the last 30days. One in 5 NH residents had received antibiotics within the last 30days, of which 45% were for UTI. The most significant factors independently associated with antibiotics for UTI were urinary catheter (OR=13, 95% CI=2.4-67, P=.003), urinary frequency (OR=10, 95% CI=2.2-47, P=.003), fever (OR=10, 95% CI=1.3-85, P=.028), new-onset hypotension (OR=10, 95% CI=1.4-73, P=.024), and confusion (OR=8.9, 95% CI=3.1-26, P<.001). Of these, confusion was the most prevalent factor in the population. Conclusion: UTI is commonly documented in NH residents, with new or worsening confusion being one of the strongest factors associated with antibiotic treatment for suspected UTI

Agreement between rapid antigen detection test and culture for group A streptococcus in patients recently treated for pharyngotonsillitis-a prospective observational study in primary care

ObjectiveThe aim was to compare rapid antigen detection test (RADT) and throat culture for group A streptococci (GAS) among patients recently treated with penicillin V for GAS pharyngotonsillitis.Design and settingThe study was a secondary analysis within a randomized controlled trial comparing 5 versus 10 days of penicillin V for GAS pharyngotonsillitis. Patients were recruited at 17 primary health care centres in Sweden.SubjectsWe included 316 patients &amp;gt;= 6 years of age, having 3-4 Centor criteria, a positive RADT and a positive throat culture for GAS at inclusion, and also having a RADT and throat culture for GAS taken at a follow-up visit within 21 days.Main outcome measuresRADT and conventional throat culture for GAS.ResultsThis prospective study showed 91% agreement between RADT and culture at follow-up within 21 days. Only 3/316 participants had negative RADT with a positive throat culture for GAS at follow-up, and 27/316 patients with positive RADT had a negative culture for GAS. Log rank test did not reveal any difference in the decline over time of positive tests between RADT and throat culture (p = 0.24). Agreement between RADT and throat culture for GAS at the follow-up was not associated with treatment duration, number of days from inclusion until follow-up, throat symptoms at follow-up, gender, or age.ConclusionRADT and culture for GAS agreed to a high extent also after recent penicillin V treatment. RADT for GAS means a low risk for missing the presence of GAS

Effects of penicillin V on the faecal microbiota in patients with pharyngotonsillitis-an observational study

Background The intestinal microbiota functions as a reservoir of antibiotic resistance. Objectives To evaluate penicillin V (phenoxymethylpenicillin) effects on the faecal microbiota with focus on beta-lactam resistance. Methods We included 31 primary care patients with group A streptococcal pharyngotonsillitis treated with penicillin V for 5 (800 mg x 4) or 10 days (1000 mg x 3). Twenty-nine patients contributed with three faecal swab samples each. The faecal specimens were collected at the start of penicillin V treatment, after the last dose and at follow-up 7-9 days after completed treatment. Samples were inoculated semiquantitatively on selective screening agar plates to study beta-lactam resistance, species shifts among Enterobacterales and enterococci, and colonization with Candida spp. and Clostridioides difficile. Representative colonies were identified using MALDI-TOF. Results were analysed by non-parametric statistical methods. Results An increase in the proportion of patients colonized with ampicillin-resistant Enterobacterales, from 52% to 86% (P = 0.007), and Enterobacterales with decreased susceptibility to third-generation cephalosporins, from 32% to 52% (P = 0.034), was observed between the first and second samples. This increase was no longer significant at follow-up. New colonization with ampicillin-resistant Enterobacterales species and non-Enterobacterales Gram-negative species was observed, and persisted at follow-up. Conclusions Following treatment with penicillin V, we observed decreased susceptibility to ampicillin and third-generation cephalosporins, and prolonged colonization with non-Escherichia coli Gram-negative species. These findings challenge the perception that penicillin V has limited ecological effect on the intestinal microbiota, and emphasizes the importance of avoiding even narrow-spectrum antimicrobials when possible.Funding Agencies|Public Health Agency of Sweden; Healthcare Committee, Region Vaestra Goetaland; Axel Linders Foundation; Skaraborg Institute [19/1039]</p