Urinary tract infections in extended care facilities: preventive management strategies.

OBJECTIVE: To provide health care professionals with an overview of interventions that may be done to reduce the incidence of urinary tract infections (UTIs) in elderly patients, especially those residing in extended care facilities. DATA SOURCES: A Medline search of the English literature was performed from 1980 to January 2006 to find literature relevant to urinary tract prophylaxis. Further references were hand-searched from relevant sources. STUDY SELECTION: When assessing the effectiveness of various clinical interventions for reducing the incidence of UTIs in the elderly, preference was given to more recent, double-blind, placebo-controlled randomized studies, but studies of less robust design also were included in the discussions when the former were lacking. DATA EXTRACTION: Where possible, recent publications were favored over older studies. References were all reviewed by the authors and chosen to present key citations. DATA SYNTHESIS: Data selection was prioritized to address specific subtopics.
CONCLUSION: Though still frequent in occurrence and quite costly in terms of morbidity, mortality, and cost to the health care system, numerous measures may be taken to ameliorate the incidence of UTIs in elderly, institutionalized residents. First and foremost, establishing and adhering to good infection-control practices by health care givers and minimizing the use of indwelling catheters are essential. Adequate staffing and training are germane to this effort. Reasonably well-designed clinical studies also give credence to the use of topical estrogens and lactobacillus "probiotics" for female subgroups and cranberry juice for a wider array of patients. Vitamin C is of no proven benefit. With regard to antibiotics, with the relative paucity of data available for this patient population, concerns for resistance proliferation must be balanced against perceived gains in UTI reduction.