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Comment & Response |

Further Misanalysis of Urinalysis—Reply

Kathryn B. Holroyd1; Alexander Rittenberg, MD1; Amit Pahwa, MD1
[+] Author Affiliations
1The Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Intern Med. 2016;176(9):1408. doi:10.1001/jamainternmed.2016.4510.
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In Reply We would like to thank Dr Drekonja for his commentary on our article1 and agree that screening for or treatment of asymptomatic bacteriuria from chronic indwelling urinary catheters is not recommended by the Infectious Diseases Society of America (IDSA). In the 2005 IDSA guidelines2 on asymptomatic bacteriuria, the recommended strength is grade A-I (ie, “Good evidence to support a recommendation for use; should always be offered” based on “evidence from ≥ 1 randomized, controlled trial”). Our manuscript, however, mentioned a different condition termed asymptomatic persistent catheter-acquired bacteriuria. The same 2005 asymptomatic bacteriuria guidelines2 go on to state that “Antimicrobial treatment of asymptomatic women with catheter-acquired bacteriuria that persists 48 [hours] after catheter removal may be considered” and carries grade B-I recommendation strength (ie, “Moderate evidence to support a recommendation for use; should generally be offered”). Notably, in the subsequent 2009 IDSA guidelines3 on catheter-associated urinary tract infections, this recommendation was downgraded to grade C-I (ie, “Poor evidence to support a recommendation for…use”).

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September 1, 2016
Dimitri Drekonja, MD, MS
1Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
JAMA Intern Med. 2016;176(9):1407. doi:10.1001/jamainternmed.2016.4503.
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