CLINICAL QUESTION

Do antibiotics improve outcomes in adults with delirium and pyuria or bacteriuria?

BOTTOM LINE

The authors of this systematic review found only four low-quality studies, none of which reported that antibiotics improved delirium in adults with asymptomatic pyuria or bacteriuria. (Level of Evidence = 2a−)

SYNOPSIS

The authors searched Medline, EMBASE, and the reference lists of included studies and key review papers. They included randomized and nonrandomized studies of afebrile adults 60 years and older with delirium and bacteriuria or pyuria and no urinary symptoms. They found only four studies (652 participants): one randomized trial, two prospective cohort studies, and one retrospective cohort study. One of the cohort studies was at moderate risk of bias, and the remaining three were at high risk of bias. None of the studies reported a positive effect of antibiotics on delirium outcomes.

Study design: Systematic review

Funding source: Self-funded or unfunded

Setting: Various (meta-analysis)

Reference: Stall NM, Kandel C, Reppas-Rindlisbacher C, et al. Antibiotics for delirium in older adults with pyuria or bacteriuria: a systematic review. J Am Geriatr Soc. 2024;72(8):2566-2578.