2025/11/06 by Alistair Thorpe, Rachael A Lee, Julia E. Szymczak +6 · 1 voice
Immunology and Microbiology · Medicine · #Antibiotic Use and Resistance #Pediatric Urology and Nephrology Studies #Urinary Tract Infections Management
paper · pdf · doi:10.1093/ofid/ofaf690
openalex publication_date 2025/11/06 · openalex created_date 2025/12/16 · openalex updated_date 2026/07/30
Abstract Background Adults aged ≥65 years are at high risk of harm from antibiotic misuse due to misdiagnosis of asymptomatic bacteriuria (ASB) as urinary tract infection (UTI). Alongside strategies to improve prescribing, patients should be informed and empowered to discuss the harms/benefits of antibiotic treatment. We tested whether a patient-focused educational leaflet improved reported willingness to avoid antibiotics when not clinically necessary. Methods In an online randomized controlled survey experiment, US adult respondents aged ≥65 years read a scenario of themselves as an asymptomatic patient with a positive urine test before a nonurologic surgical procedure. They were assigned to 1 of 4 conditions, which varied by educational leaflet provision and surgeons' treatment recommendation for antibiotics. The primary outcome was respondents' comfort with not taking antibiotics for ASB. Secondary outcomes were reported misperceptions of ASB as UTI and knowledge. Results Of the 504 respondents (completion = 89%), the mean age was 72, 64.5% identified as male, 53.4% identified as Non-Hispanic White, and 35.7% reported prior antibiotic prescriptions for UTI. In response to the vignette, respondents shown the leaflet were more comfortable not taking antibiotics (P < .001), were less likely to misperceive ASB as a UTI (P < .001), and displayed greater knowledge (P < .001). Respondents told that the surgeon recommends antibiotics were less comfortable not taking antibiotics (P = .013) and more likely to misperceive ASB as UTI (P < .001). Conclusions In an online randomized controlled survey experiment, a patient-centered educational leaflet decreased reported desires to take antibiotics for ASB and improved knowledge among US adults age ≥65 years. Patient-focused education may prepare patients to engage in antibiotic treatment decisions.