Antibiotics for Delirium in Older Adults With No Clear Urinary Tract Infection

Last updated: September 9, 2024
Sponsor: Mount Sinai Hospital, Canada
Overall Status: Active - Recruiting

Phase

N/A

Condition

Dementia

Urinary Tract Infections

Treatment

Start Antibiotics / Continue Antibiotics for treatment of bacteriuria

No Antibiotics for treatment of bacteriuria

Clinical Study ID

NCT06004739
CTO 4466
  • Ages > 60
  • All Genders

Study Summary

Delirium is an acute confusional state that is experienced by many older adults who are admitted to hospital. To treat delirium the underlying cause needs to be identified promptly, but this is challenging. One of the potential causes of delirium is infection. Urine tests show that most patients experiencing delirium have bacteria in their urine, however, bacteria in the urine is common among older adults, and does not automatically indicate an infection is present. As a result it is difficult to know whether a lower urinary tract infection is present as individuals with delirium are frequently unable to report clinical signs of infection - symptoms of pain or discomfort with urination, having to urinate more frequently or pelvic discomfort. Very often, individuals with delirium are treated with antibiotics despite the fact that it is unknown whether antibiotics help to improve delirium in cases where bacteria in the urine is present. This proposed study is a randomized controlled trial that will examine if adults (age 60 or older) with delirium and suspected infection benefit from taking antibiotics.

Eligibility Criteria

Inclusion

Inclusion criteria

  • Age ≥ 60 and admitted to a hospital ward (including rehabilitation hospital);

  • Active delirium (defined by CAM: [1] inattention AND [2] acute and fluctuating level of consciousness, and either [3] disorganized thinking OR [4] altered mental status; OR physician's diagnosis)

  • Less than 24 hours of antibiotics (prior to trial assessment)

  • Either pyuria (defined as white blood cells detected on urinalysis or dipstick) or bacteriuria (defined as bacteria growing on urine culture)

Exclusion criteria

  • Fever (temperature > 37.9C or > 100.2F) in the past 48 hours;

  • Signs of lower urinary tract infection symptoms (such as new dysuria) or upper urinary symptoms (such as costovertebral tenderness)

  • In the opinion of the treating physician, there is a reason apart from delirium and urine test results to treat with antibiotics (e.g., pneumonia)

  • Indwelling urinary catheter for > 72 hours

  • Receipt of an antibiotic where a single dose suffices for the treatment of a UTI (such as Fosfomycin)

Study Design

Total Participants: 550
Treatment Group(s): 2
Primary Treatment: Start Antibiotics / Continue Antibiotics for treatment of bacteriuria
Phase:
Study Start date:
May 18, 2024
Estimated Completion Date:
September 30, 2027

Connect with a study center

  • Sault Area Hospital

    Sault Ste. Marie, Ontario
    Canada

    Site Not Available

  • The Ottawa Hospital Civic Campus

    Ottawa,
    Canada

    Site Not Available

  • The Ottawa Hospital General Campus

    Ottawa,
    Canada

    Site Not Available

  • Hennick Bridgepoint Hospital

    Toronto,
    Canada

    Site Not Available

  • Michael Garron Hospital

    Toronto,
    Canada

    Active - Recruiting

  • Mount Sinai Hospital

    Toronto,
    Canada

    Active - Recruiting

  • Toronto General Hospital

    Toronto,
    Canada

    Site Not Available

  • Northwestern Memorial Hospital

    Chicago, Illinois 60611
    United States

    Site Not Available

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