Antibiotics for delirium in older adults with pyuria or bacteriuria: A systematic review.

Autor: Stall NM; Division of General Internal Medicine and Geriatrics, Sinai Health and the University Health Network, Toronto, Canada.; Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Canada.; Department of Medicine, University of Toronto, Toronto, Canada., Kandel C; Department of Medicine, University of Toronto, Toronto, Canada.; Michael Garron Hospital, Toronto East Health Network, Toronto, Canada., Reppas-Rindlisbacher C; Division of General Internal Medicine and Geriatrics, Sinai Health and the University Health Network, Toronto, Canada.; Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Canada.; Department of Medicine, University of Toronto, Toronto, Canada., Quinn KL; Division of General Internal Medicine and Geriatrics, Sinai Health and the University Health Network, Toronto, Canada.; Department of Medicine, University of Toronto, Toronto, Canada., Wiesenfeld L; Division of Psychiatry, Sinai Health, Toronto, Canada.; Department of Psychiatry, University of Toronto, Toronto, Canada., MacFadden DR; Department of Medicine, University of Ottawa, Ottawa, Canada.; The Ottawa Hospital Research Institute, Ottawa, Canada., Johnstone J; Department of Medicine, University of Toronto, Toronto, Canada.; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.; Infection Prevention and Control, Sinai Health, Toronto, Canada.; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada., Fralick M; Division of General Internal Medicine and Geriatrics, Sinai Health and the University Health Network, Toronto, Canada.; Department of Medicine, University of Toronto, Toronto, Canada.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2024 Jun 19. Date of Electronic Publication: 2024 Jun 19.
DOI: 10.1111/jgs.18964
Abstrakt: Background: It is unclear whether antibiotics impact delirium outcomes in older adults with pyuria or bacteriuria in the absence of systemic signs of infection or genitourinary symptoms.
Methods: We registered our systematic review protocol with PROSPERO (CRD42023418091). We searched the Medline and Embase databases from inception until April 2023 for studies investigating the impact of antimicrobial treatment on the duration and severity of delirium in older adults (≥60 years) with pyuria (white blood cells detected on urinalysis or dipstick) or bacteriuria (bacteria growing on urine culture) and without systemic signs of infection (temperature > 37.9C [>100.2F] or 1.5C [2.4F] increase above baseline temperature, and/or hemodynamic instability) or genitourinary symptoms (acute dysuria or new/worsening urinary symptoms). Two reviewers independently screened search results, abstracted data, and appraised the risk of bias. Full-text randomized controlled trials (RCTs) and observational study designs were included without restriction on study language, duration, or year of publication.
Results: We screened 984 citations and included 4 studies comprising 652 older adults (mean age was 84.6 years and 63.5% were women). The four studies were published between 1996 and 2022, and included one RCT, two prospective observational cohort studies, and one retrospective chart review. None of the four studies demonstrated a significant effect of antibiotics on delirium outcomes, with two studies reported a worsening of outcomes among adults who received antibiotics. The three observational studies included had a moderate or serious overall risk of bias, while the one RCT had a high overall risk of bias.
Conclusions: Our systematic review found no evidence that treatment with antibiotics is associated with improved delirium outcomes in older adults with pyuria or bacteriuria and without systemic signs of infection or genitourinary symptoms. Overall, the evidence was limited, largely observational, and had substantial risk of bias.
(© 2024 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)
Databáze: MEDLINE
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