Antibiotics fail to Improve Delirium Outcomes in Older Adults with Pyuria or Bacteriuria, unravels research

Delirium is a common and serious condition in older adults, often leading to longer hospital stays and increased mortality. Pyuria (the presence of white blood cells in the urine) and bacteriuria (the presence of bacteria in the urine) are frequently detected in older adults, raising concerns about their potential role in causing or exacerbating delirium. However, the clinical significance of these findings in the absence of infection symptoms remains unclear.

The systematic review, registered with PROSPERO (CRD42023418091), aimed to investigate whether antimicrobial treatment affects the duration and severity of delirium in older adults aged 60 and above with pyuria or bacteriuria but without systemic infection signs or genitourinary symptoms. The Medline and Embase databases were searched from their inception until April 2023. The review included randomized controlled trials (RCTs) and observational studies. Two reviewers independently screened search results, abstracted data, and appraised the risk of bias.

The study findings were as follows:

• From 984 citations screened, four studies were included in the review, encompassing 652 older adults with a mean age of 84.6 years, of whom 63.5% were women.

• These studies included one RCT, two prospective observational cohort studies, and one retrospective chart review, published between 1996 and 2022.

• None of the studies showed a significant effect of antibiotics on delirium outcomes.

• In fact, two studies reported worsening outcomes among those who received antibiotics.

• The observational studies had a moderate to serious risk of bias, while the RCT had a high risk of bias.

The findings from this review show the lack of evidence supporting the use of antibiotics to treat delirium in older adults with pyuria or bacteriuria when there are no signs of systemic infection or genitourinary symptoms. Given the potential for adverse effects and the development of antibiotic resistance, the indiscriminate use of antibiotics in such cases should be reconsidered. The current evidence is limited and predominantly observational, with substantial risks of bias.

Reference:

Stall, N. M., Kandel, C., Reppas-Rindlisbacher, C., Quinn, K. L., Wiesenfeld, L., MacFadden, D. R., Johnstone, J., & Fralick, M. (2024). Antibiotics for delirium in older adults with pyuria or bacteriuria: A systematic review. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.18964