Abstract
BackgroundThe diagnosis of urinary tract infections (UTIs) in institutionalized older adults is often based on vague symptoms and a positive culture. The high prevalence of asymptomatic bacteriuria (ABU), which cannot be easily discriminated from an acute infection in this population, is frequently neglected, leading to a vast over-prescription of antibiotics. This study aimed to identify subpopulations predisposed to transient or long-term ABU.MethodsResidents in a long-term care facility were screened for ABU. Mid-stream urine samples were collected during two sampling rounds, separated by 10 weeks, each consisting of an initial and a confirmative follow-up sample.ResultsABU occurred in approximately 40% of the participants and was mostly caused by Escherichia coli. Long-term ABU (> 3 months) was found in 30% of the subjects. The frailest women with urinary incontinence and dementia had drastically increased rates of ABU and especially long-term ABU. ABU was best predicted by a scale describing the functional independence of older adults.ConclusionsInstitutionalized women with incontinence have ABU prevalence rates of about 80% and are often persistent carriers. Such prevalence rates should be considered in clinical decision making as they devalue the meaning of a positive urine culture as a criterion to diagnose UTIs. Diagnostic strategies are urgently needed to avoid antibiotic overuse and to identify patients at risk to develop upper UTI.
Highlights
The diagnosis of urinary tract infections (UTIs) in institutionalized older adults is often based on vague symptoms and a positive culture
We identified prevalence rates, causal species and risk factors associated with asymptomatic bacteriuria (ABU) and long-term ABU in a Long-term care facility (LTCF)
The LTCF consists of a nursing home (101 beds), housing residents who are dependent in their activities of daily living in varying degrees, and a residential home (45 beds), accommodating older people with a higher degree of self-reliance
Summary
The diagnosis of urinary tract infections (UTIs) in institutionalized older adults is often based on vague symptoms and a positive culture. The high prevalence of asymptomatic bacteriuria (ABU), which cannot be discriminated from an acute infection in this population, is frequently neglected, leading to a vast over-prescription of antibiotics. Institutionalized older adults, especially those with mental impairment or chronic symptoms, are often incapable of recognizing or communicating the presence of symptoms [3, 4]. This geriatric population frequently exhibits atypical manifestations of acute disease and presents with nonspecific symptoms. There is increasing evidence that ABU protects against infection [9, 10]
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