Abstract
BACKGROUNDCatheterization facilitates continuous bacteriuria, for which the clinical significance remains unclear. This study aimed to determine the clinical presentation, epidemiology, and dynamics of bacteriuria in a cohort of long-term catheterized nursing home residents.METHODSProspective urine culture, urinalysis, chart review, and assessment of signs and symptoms of infection were performed weekly for 19 study participants over 7 months. All bacteria ≥ 1 × 103 cfu/mL were cultured, isolated, identified, and tested for susceptibility to select antimicrobials.RESULTSIn total, 226 of the 234 urine samples were polymicrobial (97%), with an average of 4.7 isolates per weekly specimen. A total of 228 urine samples (97%) exhibited ≥ 1 × 106 CFU/mL, 220 (94%) exhibited abnormal urinalysis, 126 (54%) were associated with at least 1 possible sign or symptom of infection, and 82 (35%) would potentially meet a standardized definition of catheter-associated urinary tract infection (CAUTI), but only 3 had a caregiver diagnosis of CAUTI. Bacterial isolates (286; 30%) were resistant to a tested antimicrobial agent, and bacteriuria composition was remarkably stable despite a combined total of 54 catheter changes and 23 weeks of antimicrobial use.CONCLUSIONBacteriuria composition was largely polymicrobial, including persistent colonization by organisms previously considered to be urine culture contaminants. Neither antimicrobial use nor catheter changes sterilized the urine, at most resulting in transient reductions in bacterial burden followed by new acquisition of resistant isolates. Thus, this patient population exhibits a high prevalence of bacteriuria coupled with potential indicators of infection, necessitating further exploration to identify sensitive markers of true infection.FUNDINGThis work was supported by the NIH (R00 DK105205, R01 DK123158, UL1 TR001412).
Highlights
Urinary catheter placement in healthcare settings is a common medical procedure utilized in the treatment of 60% of critically ill patients, 20% of those in medical and surgical intensive care units, and 5%–22% of residents in long-term care facilities [1,2,3,4,5,6]
Bacterial isolates (286; 30%) were resistant to a tested antimicrobial agent, and bacteriuria composition was remarkably stable despite a combined total of 54 catheter changes and 23 weeks of antimicrobial use
Urinary catheters facilitate the presence of bacteria in urine as they bypass many of the natural defenses of the urinary tract
Summary
Urinary catheter placement in healthcare settings is a common medical procedure utilized in the treatment of 60% of critically ill patients, 20% of those in medical and surgical intensive care units, and 5%–22% of residents in long-term care facilities [1,2,3,4,5,6]. This is true in nursing homes, where 12%–15% of newly admitted individuals have an indwelling urinary catheter and 5%–10% will have long-term urinary catheter use for indications such as chronic pressure ulcers or wounds, traumatic pelvic injury, neurogenic bladder, and low overall functional status [4, 7,8,9]. This study aimed to determine the clinical presentation, epidemiology, and dynamics of bacteriuria in a cohort of long-term catheterized nursing home residents
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