Bacteriuria In Older Adults Research Articles

Assessing clinicians' and trainees' knowledge and practice of the IDSA guidelines for asymptomatic bacteriuria in older adults.

A survey of advanced practice clinicians (APCs), physicians, residents, and medical students at an academic medical center and community practices in southeastern Texas revealed a gap in knowledge and practice related to testing and treatment for asymptomatic bacteriuria (ASB) in older adults.

Inpatient clinicians' approach to diagnosis of urinary tract infections in older adults using the COM-B model: a qualitative assessment.

Our interviews of inpatient clinicians (physicians, physician assistants) modeled after the Capability, Opportunity, and Motivation Model of Behavior model revealed opportunity and motivation as important drivers for overdiagnosis and overprescribing for asymptomatic bacteriuria in older adults. Understanding these barriers is an important step toward implementing age-friendly stewardship interventions.

Re: Asymptomatic Bacteriuria in Older Adults: The Most Fragile Women Are Prone to Long-Term Colonization.

No AccessJournal of UrologyUrological Survey1 Jul 2020Re: Asymptomatic Bacteriuria in Older Adults: The Most Fragile Women Are Prone to Long-Term Colonization Tomas L. GrieblingMD, MPH Tomas L. GrieblingTomas L. Griebling More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001043.03AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Asymptomatic Bacteriuria in Older Adults: The Most Fragile Women Are Prone to Long-Term Colonization." The Journal of Urology, 204(1), pp. 164–165 © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 204Issue 1July 2020Page: 164-165 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tomas L. Griebling More articles by this author Expand All Advertisement PDF DownloadLoading ...

Asymptomatic bacteriuria in older adults: the most fragile women are prone to long-term colonization

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.

Treat the Resident, Not the Urine: Using Patient Safety to Reduce Urinary Tract Infections and Overuse of Urine Culture in Long Term Care

BACKGROUND The American Geriatric Society recommends physicians do not use antibiotics to treat bacteriuria in older adults unless specific urinary tract symptoms are present. The Infectious Disease Society of America (IDSA), states screening for, and treatment of asymptomatic bacteria is not recommended for elderly, institutionalized persons. During implementation of a Nurse Driven Protocol for Foley catheter removal, it was noted many cultures were requested based on urine appearance and perceived mental status change in non-catheterized patients. To reduce unnecessary urine cultures and avoid treatment of asymptomatic residents, our team implemented a program to empower and educate staff on appropriate patient assessment for signs and symptoms of Urinary Tract Infection(UTI). Management of alternate causes were encouraged. Cultures were requested only when clinical indicators were observed. METHODS Our team initiated education on patient safety and employee empowerment. Nursing staff were empowered to use clinical assessment and surveillance definitions to guide patient management before requesting culture or antibiotics. Education included understanding constitutional criteria in the long-term care resident, and appropriate indication for culture in symptomatic and asymptomatic residents. IDSA and Agency for Healthcare Research and Quality (AHRQ) guidelines were used. Data analysis accessed Long-Term Care (LTC) Minimum Data Set (MDS) -Based Quality Measures for percent of residents with a UTI and review of the total numbers of urine cultures ordered pre- and post project implementation. All positive cultures were reviewed for infection using the CDC surveillance definitions for long term care. RESULTS The quality measure for UTI in LTC was reduced from a rate of 9.29 (13 events) in 2016, to 0.66 (1 event) in 2018. Requests for urine cultures were reduced by 54%. CONCLUSIONS Employee education and empowerment to guide management strategies in residents demonstrating a change in urine appearance or mental status change resulted in a reduction of UTI.

Overprescribing antibiotics for asymptomatic bacteriuria in older adults: a case series review of admissions in two UK hospitals

BackgroundOverdiagnosis and overtreatment of urinary tract infection (UTI) with antibiotics is a concern. In older adults, diagnosis of UTI using near-patient urine tests (reagent strip tests, dipsticks) is advised against because the age-related increase in asymptomatic bacteriuria can cause false-positive results. Instead, UTI diagnosis should be based on a full clinical assessment. Previous research lacks systematic information on urine dipstick use in hospitals. The aim of this study was to examine the use of urine dipstick tests and microbiology among older adult hospital admissions in relation to recommended UTI diagnostic criteria. A further aim was to assess factors associated with the use of dipsticks.MethodsA case series review of patients aged ≥70 years admitted to two NHS Trust hospitals in England. Records from 312 patients admitted in 2015 meeting inclusion criteria were selected at random.ResultsOf 298 complete patient records, 54% had at least one urine dipstick test recorded. 13% (21/161) of patients who received a urine dipstick test were diagnosed as having a UTI, only 2 out of these 21 cases had two or more clinical signs and symptoms. 60 patients received a second dipstick test, leading to 13 additional cases of UTI diagnosis. Dipstick tests were more likely to be performed on patients with a history of falls (OR 1.93, 95% CI:1.21, 3.07, p < 0.01), and less likely on those with dementia (OR 0.44, 95% CI: 0.22, 0.87, p < 0.05). The most common reason for testing was routine admissions policy (49.1% of cases), but these cases were predominantly in one hospital.ConclusionsUse of urine dipstick tests was high among older adults admitted to hospitals. Most cases were asymptomatic and therefore received inappropriate antibiotic therapy. This paper highlights the need to implement new Public Health England diagnostic guidelines to hospital admission and emergency departments.

Alternative to antibiotics for managing asymptomatic and non-symptomatic bacteriuria in older persons: a review.

Recurrent urinary tract infection (UTI) is one of the most common reasons for long-term antibiotic use in frail older people, and these individuals often have non-symptomatic bacteriuria. This article reviews the literature and recommendations for the treatment of UTIs particularly in the older population (>65 years). It considers the question: is there an alternative for antibiotics for asymptomatic and non-symptomatic bacteriuria in older adults? D-mannose powder has been recommended for the treatment of UTIs, as when applied locally, it reduces the adherence of Escherichia coli. In one study, D-mannose was reviewed for the prophylaxis of recurrent UTIs in women, and the findings indicated that it may be useful for UTI prevention instead of prophylactic antibiotics. There is a lack of information about the efficacy of cranberry products combined with D-mannose in this regard, and this is an area for further research.

Urinary tract infections in the elderly

Urinary tract infections (UTIs) and asymptomatic bacteriuria are frequent in elderly patients. Distinguishing UTI from asymptomatic bacteriuria in older adults, particularly those living in long-term care facilities, might be achallenge for physicians due to the presence of confounding factors, such as an overactive bladder, prostate enlargement, and an indwelling bladder catheter. The absence of standards in the definition and treatment of UTI in the elderly frequently leads to overtreatment. Consequently, antibiotic selection pressure increases and as aresult multidrug-resistant organisms might arise. On the other hand, insufficient treatment can result in prolonged and complicated courses of infections or increased morbidity. This review covers the definition, prevalence, diagnosis and management of UTI in older adults.

Asymptomatic Bacteriuria in Older Adults

Asymptomatic bacteriuria is a common finding in older populations. The prevalence increases with age in both men and women and is the highest in the most functionally impaired. Subjects with chronic indwelling catheters are always bacteriuric. Current management issues include the continuing need to refine clinical features identifying symptomatic infection and developing effective strategies to minimize inappropriate antimicrobial use for the treatment of asymptomatic bacteriuria. These are particularly relevant for residents of long-term care facilities where this is a high prevalence of bacteriuria. Recent reports continue to describe substantial antimicrobial treatment of asymptomatic bacteriuria in older populations in both acute and long-term care facilities. Comprehensive antimicrobial stewardship programs are effective in decreasing inappropriate use, including innovative strategies such as non-reporting of urine culture results. However, the durability of such programs remains uncertain.

Urinary tract infections and asymptomatic bacteriuria in older adults.

Overuse of urinalysis in older adults to investigate vague changes in condition such as confusion, lethargy, and anorexia, has led to overtreatment of asymptomatic bacteriuria and associated antibiotic resistance.

Urinary Tract Infection in Older Adults

Urinary tract infection and asymptomatic bacteriuria are common in older adults. Unlike in younger adults, distinguishing symptomatic urinary tract infection from asymptomatic bacteriuria is problematic, as older adults, particularly those living in long-term care facilities, are less likely to present with localized genitourinary symptoms. Consensus guidelines have been published to assist clinicians with diagnosis and treatment of urinary tract infection; however, a single evidence-based approach to diagnosis of urinary tract infection does not exist. In the absence of a gold standard definition of urinary tract infection that clinicians agree upon, overtreatment with antibiotics for suspected urinary tract infection remains a significant problem, and leads to a variety of negative consequences including the development of multidrug-resistant organisms. Future studies improving the diagnostic accuracy of urinary tract infections are needed. This review will cover the prevalence, diagnosis and diagnostic challenges, management, and prevention of urinary tract infection and asymptomatic bacteriuria in older adults.

FEASIBILITY OF CRANBERRY CAPSULE ADMINISTRATION AND CLEAN‐CATCH URINE COLLECTION IN LONG‐TERM CARE RESIDENTS

FEASIBILITY OF CRANBERRY CAPSULE ADMINISTRATION AND CLEAN‐CATCH URINE COLLECTION IN LONG‐TERM CARE RESIDENTS

Asymptomatic Bacteriuria in Older Adults

The incidence of asymptomatic bacteriuria increases with age, and thus it is a common finding in older adults, especially the very old and the institutionalized. Bacteriuria in most older adults, while common, is often transient. The clinical significance is generally minor and the treatment yields very little benefit, is expensive, and may cause substantial drug toxicity. Guidelines to help determine which patients may benefit from treatment are included. Primary care providers for older adults in ambulatory, home, hospital, or institutional settings, should recognize asymptomatic bacteriuria and know when and when not to treat. This management decision will become an increasingly important aspect of gerontological health care.