{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T01:58:20Z","timestamp":1785463100127,"version":"3.56.0"},"reference-count":27,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T00:00:00Z","timestamp":1779494400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T00:00:00Z","timestamp":1779494400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000241","name":"Physicians' Services Incorporated Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000241","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004733","name":"TD Bank","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004733","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015680","name":"J.P. Bickell Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015680","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011251","name":"Northern Ontario Academic Medicine Association","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011251","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>It is unclear whether antibiotics improve outcomes for older adults with delirium who have pyuria or bacteriuria in the absence of other signs or symptoms of a urinary tract infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Our study is a multicenter, parallel\u2010group, single\u2010blinded, non\u2010inferiority pragmatic randomized trial. The trial included a vanguard phase of the first 30 participants, and herein we report the aggregate results from this phase. We included hospitalized adults aged 60\u2009years and older who had delirium and pyuria and\/or bacteriuria. We excluded patients with fever, upper or lower urinary tract symptoms, an indwelling foley for more than 72\u2009h, more than 24\u2009h of antibiotics at the time of eligibility, or another indication for antibiotics (e.g., pneumonia). The main outcomes of the vanguard phase were rates of participant recruitment, protocol adherence, and study withdrawal. Our initial goals were 4 patients randomized monthly per site, greater than 95% adherence to allocation, and less than 5% withdrawal rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median age was 86\u2009years (interquartile range [IQR] 81\u201392), 68% were female, and most (79%) had either minor or major neurocognitive impairment. Of the participating sites that recruited at least one participant, the recruitment rates ranged from 0.05 to 1.8 participants per month. Adherence to allocation was 100%. Two participants (6.7%) withdrew. For participants randomized to receive antibiotics, the median duration was 5\u2009days (IQR 5\u20137). By Day 7, delirium had resolved in 39% of the participants who remained hospitalized; 25% of participants were discharged, 32% had ongoing delirium, and 4% did not have a delirium assessment available. By Day 7, 1 (3.6%) developed\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>C. difficile<\/jats:italic>\n                      <\/jats:styled-content>\n                      , 1 (3.6%) died, and 1 (3.6%) developed bacteremia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We completed our vanguard phase with 100% adherence to allocation and withdrawal was near the target of 5%. The recruitment rate varied widely and overall was lower than anticipated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70480","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T07:58:41Z","timestamp":1779523121000},"page":"1964-1970","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Antibiotics for Delirium in Older Adults With No Clear Urinary Tract Infection: A Multicentre, Pragmatic, Randomized Trial\u2014Vanguard Results"],"prefix":"10.1111","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2082-2445","authenticated-orcid":false,"given":"Michael","family":"Fralick","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics Sinai Health System  Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Lunenfeld\u2010Tanenbaum Research Institute Sinai Health System  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan M.","family":"Stall","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics Sinai Health System  Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Lunenfeld\u2010Tanenbaum Research Institute Sinai Health System  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Zorcic","sequence":"additional","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute Sinai Health System  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Reppas\u2010Rindlisbacher","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics Sinai Health System  Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Kaplovitch","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics Sinai Health System  Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy S.","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine Sinai Health System  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek R.","family":"MacFadden","sequence":"additional","affiliation":[{"name":"The Ottawa Hospital Research Institute  Ottawa Ontario Canada"},{"name":"Department of Medicine University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1812-2335","authenticated-orcid":false,"given":"Daniel","family":"Kobewka","sequence":"additional","affiliation":[{"name":"The Ottawa Hospital Research Institute  Ottawa Ontario Canada"},{"name":"Department of Medicine University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Castellani","sequence":"additional","affiliation":[{"name":"Division of Clinical Sciences NOSM University  Sudbury Ontario Canada"},{"name":"Department of Infection Prevention and Control Sault Area Hospital  Sault Ste. Marie Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Parsons","sequence":"additional","affiliation":[{"name":"Division of Clinical Sciences NOSM University  Sudbury Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"McGeer","sequence":"additional","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute Sinai Health System  Toronto Ontario Canada"},{"name":"Department of Laboratory Medicine and Pathobiology University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janine","family":"McCready","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Division of Infectious Diseases Michael Garron Hospital  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryant","family":"Lim","sequence":"additional","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute Sinai Health System  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emil","family":"Hodzic\u2010Santor","sequence":"additional","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute Sinai Health System  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Kandel","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Division of Infectious Diseases Michael Garron Hospital  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the A\u2010DONUT Study Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1605501"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.162.4.457"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(13)60688\u20101"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.130299"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010019\u20101181\u20104"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2013.10.004"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy1121"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.2871"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18964"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2017.05.010"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010022\u201003549\u20108"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i5239"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2025.08.027"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1508375"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1404380"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.024096"},{"key":"e_1_2_9_18_1","unstructured":"K.Gupta T. 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