Abstract: Urinary Tract Infections in Long-Term Care Facilities

L.E. Nicolle, MD. "Urinary Tract Infections in Long-Term Care Facilities." Infection Control and Hospital Epidemiology 14 (1993) 4: 220-225.

Objectives:
* Nicolle discusses issues pertaining to urinary tract infections in long-term care facilities, focusing primarily upon non-catheterized elderly patients in nursing homes (the author does not address issues pertaining to urinary tract infection in patients with chronic indwelling catheters, as they have been discussed in other articles). The prevalence and incidence, pathogenesis, microbiology, clinical presentation (symptoms) and morbidity and mortality associated with UTI among non-catheterized residents are reviewed, and methods of treatment and prevention are addressed.

Conclusions:
* UTI is common among residents of long-term care facilities, affecting between 15% to 50% of residents in studies performed in several different countries. Women are slightly more likely than men to acquire UTI.
* "Among the institutionalized elderly, the most functionally impaired have the greatest prevalence of bacteriuria." These include those patients with neurologic diseases (which often results in impaired bladder function), diabetes, and prostate diseases, among others.
* Intermittent catheterization or, in men, condom catheters, promote urinary tract infections by facilitating the ascent of bacteria into the bladder.
* UTI can be caused by several different organisms. E coli is the most common infecting organism among men and women in nursing homes.
* More than 90% of elderly nursing home residents with UTI will develop associated pyuria, which can lead to upper tract infection of the kidney.
* "Catheterization . . . carries a risk of introduction of infection of as much as 5% and should be limited to clinically appropriate indications."
* Symptoms of UTI range from changes in continence and increased frequency of voiding to fever and clinical pyelonephritis. UTI can be sometimes be difficult to diagnose due to the inability of many nursing home residents to communicate effectively, as well as to the presence of multiple health problems, which complicates the interpretation of symptoms. Symptoms such as incontinence, nocturia, and frequency are common among elderly residents, and are not always caused by UTI. "These diagnostic difficulties frequently lead to overtreatment of urinary infection."
* "It is clear that avoiding long-term indwelling catheters decreases the frequency of and morbidity from urinary infection. Similarly, if condom catheters can be avoided, the incidence and prevalence of urinary infection will decrease."

If you would like to read this study, please contact us and we will send a copy to you.