Enhancing the Safety of Hospitalized Patients: Who Is Minding the Antimicrobials?:  Comment on “Overtreatment of Enterococcal Bacteriuria”

Guidelines have long recommended against using antimicrobials in hospitalized patients who have bacteriuria but no symptoms of a urinary tract infection (UTI). Asymptomatic bacteriuria is commonly found in hospitalized patients, often when urine cultures are appropriately ordered in patients with complex problems for which UTI may provide one of many possible explanations. Unfortunately, when asymptomatic bacteriuria is identified, antimicrobials often follow.¹ In this issue of the Archives, Lin and colleagues² evaluate antimicrobial use in patients with enterococcal bacteriuria. The authors retrospectively reviewed medical records at 2 academic medical centers and identified 339 urine cultures that yielded enterococci. Applying the diagnostic criteria of the Infectious Diseases Society of America, the authors found that 183 of these patients had asymptomatic bacteriuria. Of all patients with enterococcal asymptomatic bacteriuria, 33% inappropriately received antimicrobials. Somewhat disturbingly, nearly 15% of patients who were legitimately diagnosed as having UTI did not receive antimicrobials. To make matters even worse, for patients with both UTI and asymptomatic bacteriuria, the most commonly used antimicrobials were quinolones, which are broad-spectrum agents with little activity against enterococci.