Online misinformation about UTIs and ASB reported

Online misinformation about UTIs and ASB reported | Image Credit: © 220 Selfmade studio - © 220 Selfmade studio - stock.adobe.com.

There is significant variation in the quality of information about urinary tract infections (UTIs) and asymptomatic bacteriuria (ASB) on the internet, according to a recent study published in JAMA Network Open.¹

ASB, defined as the presence of bacteria in the urine without signs of a UTI, is a common, benign condition. Patients with ASB, especially older adults, often receive antibiotic overtreatment because of difficulty differentiating between ASB and UTIs.¹

A prevalence of over 15% has been reported for ASB among older women, increasing to 50% among women living in long-term care facilities.² As ASB rarely leads to UTIs, patient outcomes are not improved when treating ASB using antibiotic treatment.

The Infectious Disease Society of America highlighted the risks and benefits of treating ASB in their management guidelines. Among pregnant women, ASB screening can occur during the first trimester, with treatment offered if positive.²

Appropriate ASB screening and treatment should also be provided to patients receiving endoscopic urologic procedures. In patients with neutropenia, spinal cord injuries, diabetes, and indwelling urinary catheters, clinical outcomes are improved when treating ASB.²

Adverse outcomes linked to unnecessary ASB treatment include Clostridioides difficile infection, increased antimicrobial resistance, and increased health care cost. These consequences have led many antibiotic stewardship programs in the United States to implement protocols aiming to decrease unnecessary treatment.²

Health-related information is obtained through the internet by 80% of adults in the United States.¹ Patient expectations toward symptom treatment may be impacted by unclear information or misinformation about UTIs and ASB obtained from the internet, and further misinformation may be obtained from inaccurate artificial intelligence (AI)–generated summaries.

Investigators conducted a cross-sectional study to evaluate the content and quality of information about ASB and UTIs on the internet. Information about UTIs was found through a Google Search in incognito mode performed by 3 team members between December 2023 and January 2024.¹

Four clinicians and a 5-member community advisory board identified search terms. Eligibility criteria for websites included being based in the United States, in the English language, freely accessible, and designed for nonpregnant adult individuals.¹

Information about UTI diagnosis, treatment, and prevention was assessed using a codebook reviewed and revised by the study team and clinical advisors. One of 4 researchers independently coded websites, with questions discussed to reach consensus.¹

There were 331 websites included in the final analysis, 97% of which mentioned at least 1 accurate UTI symptom and 80% mentioned at least 1 inaccurate UTI symptom. A change in urine color was the most common inaccurate symptom, mentioned by 74% of websites. This was followed by strong-smelling urine by 69%.¹

The term asymptomatic bacteriuria was only mentioned by 9% of websites, and only 3% mentioned the requirement of symptoms being present to diagnose a true UTI. The possibility of antibiotic resistance on an individual level was mentioned by only 21%, with only 9% mentioning the possibility of global antibiotic resistance and 8% adverse reactions of antibiotics.¹

These results indicated significant variability in the quality of information about ASB and UTIs available on the internet. Investigators concluded this information could lead to misconceptions about ASB and UTIs, causing inaccurate diagnosis and management.¹

References

1. Schmitz V, Troubh Z, Durkin M, et al. Quality of publicly available information about urinary tract infections. JAMA Netw Open. 2024;7(11):e2444988. doi:10.1001/jamanetworkopen.2024.44988
2. Luu T, Albarillo FS. Asymptomatic bacteriuria: prevalence, diagnosis, management, and current antimicrobial stewardship implementations.Am J Med. 2022;135(8):e236-e244. doi:10.1016/j.amjmed.2022.03.015