Online Search Strategies and Results From a Crowdsourced Survey on Asymptomatic Bacteriuria.

IMPORTANCE: Despite the prevalence of asymptomatic bacteriuria (ASB), what proportion of the population is aware of this condition and the quality of internet resources are currently unknown. OBJECTIVE: This study aimed to use an online crowdsourcing platform to explore general knowledge and internet search strategies, along with the quality of information, on ASB. STUDY DESIGN: An online survey was administered through a crowdsourcing platform to women 50 years or older via Qualtrics, which is a sophisticated online survey tool. Participants completed a survey on ASB, and participants were asked how they would search the internet for information both on urinary test results and on ASB. Outcomes included survey responses, and qualitative data were coded and analyzed thematically. χ2 Testing and regression modeling were used to look for variables associated with concern for ASB. RESULTS: There were a total of 518 participants who passed attention check qualifications, and only 45 respondents (8.7%) had heard of ASB. Many were concerned about progress to a worsening infection (n = 387 [77.6%]). When controlling for confounders, education beyond a college degree was not associated with a lower concern for ASB when compared with those with a high school education or less (adjusted odds ratio, 0.63; 95% confidence interval, 0.25-1.55; P = 0.31). Medical providers were the target audience for a majority of the websites, and many of the patient-facing results were of poor quality. CONCLUSIONS: Our national survey of women demonstrated a prevalent knowledge deficit surrounding ASB. We must seek to create high-quality, readily available, patient-facing information to increase awareness of ASB, allay concerns, and increase antibiotic stewardship.

Management of Urinary Tract Infection Symptoms in Older Women: A Survey of Practitioners.

IMPORTANCE: Urinary tract infection (UTI) is the most common bacterial infection for which empiric antibiotics are prescribed despite limited progression to urosepsis. More than half of antibiotics prescribed to older adults for a suspected UTI are considered unnecessary. OBJECTIVE: The aim of the study was to assess knowledge, attitudes, and practices regarding management of older women (>65 years) with symptoms attributed to UTIs among family and internal medicine providers. STUDY DESIGN: This cross-sectional study surveyed 330 primary care providers in November 2021 regarding management of UTI symptoms. The primary outcome was the proportion of primary care providers who felt safe waiting for urine culture results before prescribing antibiotics in older women. RESULTS: The response rate was 43.0% (n = 142) with the majority of primary care providers practicing medicine more than 15 years (56.3%). For the primary outcome, 26.1% (n = 37) of primary care providers felt safe waiting for a urine culture result before prescribing antibiotics, while 62.0% (n = 88) felt delaying antibiotics depended on multiple factors, and 9.2% (n = 13) felt it was never safe to delay antibiotics. Primary care providers that either never felt it was safe to delay antibiotics or felt that "it depends" on a variety of factors, attributed their antibiotics administration to concern for progression to sepsis (n = 50, 49.5%) or progression of symptoms (n = 28, 27.7%). A higher proportion of primary care providers practicing more than 15 years felt safe delaying antibiotics compared with primary care providers with less experience (33.8% vs 18.3%, P = 0.04), and 70.3% of those who felt safe delaying antibiotics had more than 15 years of experience. CONCLUSION: Primary care providers with more clinical experience have more comfort delaying antibiotics in older women with UTI symptoms.

Potassium Magnesium Citrate Is Superior to Potassium Chloride in Reversing Metabolic Side Effects of Chlorthalidone.

BACKGROUND: Thiazide diuretics (TD) are the first-line treatment of hypertension because of its consistent benefit in lowering blood pressure and cardiovascular risk. TD is also known to cause an excess risk of diabetes, which may limit long-term use. Although potassium (K) depletion was thought to be the main mechanism of TD-induced hyperglycemia, TD also triggers magnesium (Mg) depletion. However, the role of Mg supplementation in modulating metabolic side effects of TD has not been investigated. Therefore, we aim to determine the effect of potassium magnesium citrate (KMgCit) on fasting plasma glucose and liver fat by magnetic resonance imaging during TD therapy. METHODS: Accordingly, we conducted a double-blinded RCT in 60 nondiabetic hypertension patients to compare the effects of KCl versus KMgCit during chlorthalidone treatment. Each patient received chlorthalidone alone for 3 weeks before randomization. Primary end point was the change in fasting plasma glucose after 16 weeks of KCl or KMgCit supplementation from chlorthalidone alone. RESULTS: The mean age of subjects was 59±11 years (30% Black participants). Chlorthalidone alone induced a significant rise in fasting plasma glucose, and a significant fall in serum K, serum Mg, and 24-hour urinary citrate excretion (all P<0.05). KMgCit attenuated the rise in fasting plasma glucose by 7.9 mg/dL versus KCl (P<0.05), which was not observed with KCl. There were no significant differences in liver fat between the 2 groups. CONCLUSIONS: KMgCit is superior to KCl, the common form of K supplement used in clinical practice, in preventing TD-induced hyperglycemia. This action may improve tolerability and cardiovascular safety in patients with hypertension treated with this drug class.

The Practice of Cystoscopy with Hydrodistention Since the 2011 American Urological Association Clinical Guideline on Interstitial Cystitis/Bladder Pain Syndrome.

INTRODUCTION: We determined the rate of cystoscopy with hydrodistention (CH) before and after the 2011 American Urological Association (AUA) amended clinical guideline, "Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome." METHODS: Clinical encounters with a diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS) where cystoscopy with and without hydrodistention was performed were identified in the Vizient® Clinical Data Base between January 2009 and February 2020. Demographic and clinical information such as patient age, gender, race, treating physician specialty, insurance type and type of hospital (teaching vs nonteaching) was recorded. Descriptive statistics, Wilcoxon 2-sample test and chi-square test were used to compare variables. An interrupted time series analysis was used to assess the change in CH rate following the June 2011 AUA guideline. RESULTS: From January 2009 to February 2020, 69,983 encounters were identified to have an IC/BPS diagnosis and to have undergone outpatient cystoscopy, of which 7,502 (10.7%) were CH. Compared to those not undergoing CH, subjects with IC/BPS undergoing CH were younger, predominantly female, Caucasian and had commercial insurance. Before the guideline, across all medical specialties, the base rate of CH was rising from 16.6% at a rate of 0.12% per month. Following guideline release, the CH rate dropped by 6.8%, declining 0.07% per month until February 2020. This pattern was most pronounced in urology relative to all other medical specialties. CONCLUSIONS: The monthly average rate of CH among individuals with IC/BPS undergoing an outpatient CH dropped from nearly 17% before the 2011 AUA guideline to less than 10% in early 2020.