Impact of antibiotic treatment and predictors for subsequent infections in multidrug-resistant Pseudomonas aeruginosa catheter-associated asymptomatic bacteriuria

Background: The rate of antibiotic treatment for catheter-associated asymptomatic bacteriuria (CA-ASB) remains high.

Methods: We conducted a retrospective study involving hospitalized patients with multidrug-resistant Pseudomonas aeruginosa (MDRP) CA-ASB. Cox proportional hazards regression models were used to identify predictors for subsequent symptomatic infections in patients with MDRP CA-ASB. The probability of remaining free from symptomatic infection was analyzed using Kaplan-Meier curves.

Results: The study cohort comprised 139 patients with MDRP CA-ASB. Subsequent symptomatic MDRP infections were observed in 37 (26.6%) patients. Multivariate analysis revealed that underlying urologic diseases (HR = 2.17, 95% CI = 1.01-4.66, p = 0.047), active antibiotic treatment for MDRP (HR = 2.34, 95% CI = 1.02-5.38, p = 0.046), and recurrent bacteriuria (HR = 3.57, 95% CI = 1.73-7.38, p = 0.001) were independent predictors for subsequent symptomatic infections. The Kaplan-Meier analysis demonstrated a significantly lower cumulative proportion of symptomatic infection-free patients among those receiving active antibiotic therapy for MDRP CA-ASB than among those who did not (41.7% vs. 76.4%, p = 0.006, log-rank test).

Conclusions: These findings support the current guidelines against routine antibiotic therapy, even for MDRP CA-ASB, and emphasize the need for close monitoring and timely intervention in high-risk populations.