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

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.

Conditions

• Infectious Disease

Interventions

DRUG

Start Antibiotics / Continue Antibiotics for treatment of bacteriuria

Participants will be randomized to start or continue with antibiotics (with antibiotic duration determined by the Most Responsible Physician \[MRP\]). Antibiotics choice to be selected by the MRP.

OTHER

No Antibiotics for treatment of bacteriuria

Participants will be randomized to no antibiotics

Sponsors & Collaborators

• Sault Area Hospital

  collaborator OTHER

• Michael Garron Hospital

  collaborator OTHER

• Unity Health Toronto

  collaborator OTHER

• The Ottawa Hospital

  collaborator OTHER

• Northwestern Memorial Hospital

  collaborator OTHER

• Mount Sinai Hospital, Canada

  lead OTHER

Principal Investigators

• Michael Fralick, MD, PhD · Sinai Health System

• Chris Kandel, MD, PhD · Michael Garron Hospital

• Nathan Stall, MD, PhD · Sinai Health System

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

60 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-05-18

Primary Completion

2027-09-30

Completion

2027-09-30

Countries

• United States
• Canada

Study Locations