Prescribing antibiotics to acutely ill psychiatric patients with urine analysis indicative of infection

Abstract

Diagnosing urinary tract infections (UTIs) in acutely ill psychiatric patients is often complicated by their inability to reliably report UTI symptoms in the context of overwhelming psychiatric symptoms, like psychosis or mania. A urine analysis suggesting an infection without clinical complaints from patients would indicate asymptomatic bacteriuria (ASB). Current guidelines recommend against screening for or treating ASB in all but a few select populations. However, emerging evidence suggests increased prevalence of UTIs among acutely ill psychiatric patients, and UTIs may be contributing to the relapse or severity of psychiatric symptoms. Individuals with acute psychiatric illnesses have not been considered as a special population for the treatment of ASB. Given the potential risks of untreated infections contributing to psychiatric illnesses and the limitations of relying on subjective symptom reporting in this population, we believe that all ASB should be treated in acutely ill psychiatric patients. We also call for this population to be considered as a special population for additional study to assess whether screening for or treating ASB may improve outcomes.

Keywords: Urinary tract infection; Psychosis; Mania; Urine analysis; Antibiotics; Infection; Asymptomatic bacteriuria

Core Tip: Acutely ill psychiatric patients often cannot or are unwilling to report urinary tract infection (UTI) symptoms. This complicates current guidelines that largely discourage treating asymptomatic bacteriuria. Emerging evidence suggests a higher prevalence of UTIs during acute psychosis or mania, raising concerns that untreated infections may be causing or exacerbating psychiatric symptoms. Given the potential impact of untreated UTIs for patients with acute psychiatric disorders, we believe that asymptomatic bacteriuria should be treated in this patient population.