Erika D'Agata1, Mark B Loeb, Susan L Mitchell. 1. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA. edagata@bidmc.harvard.edu
Abstract
OBJECTIVES: To describe the presentation of suspected urinary tract infections (UTIs) in nursing home (NH) residents with advanced dementia and how they align with minimum criteria to justify antimicrobial initiation. DESIGN: Twelve-month prospective study. SETTING: Twenty-five NHs. PARTICIPANTS: Two hundred sixty-six NH residents with advanced dementia. MEASUREMENTS: Charts were abstracted monthly for documentation of suspected UTI episodes to determine whether episodes met minimum criteria to initiate antimicrobial therapy according to consensus guidelines. RESULTS: Seventy-two residents experienced 131 suspected UTI episodes. Presenting symptoms and signs for these episodes are mental status change (44.3%), fever (20.6%), hematuria (6.9%), dysuria (3.8%), costovertebral tenderness (2.3%), urinary frequency (1.5%), rigor (1.5%), urgency (0%), and suprapubic pain (0%). Only 21 (16.0%) episodes met minimal criteria to initiate antimicrobial therapy based on signs and symptoms. Of the 110 episodes that lacked minimum criteria to justify antimicrobial initiation, 82 (74.5%) were treated with antimicrobial therapy. Urinalyses and urine culture results were available for 101 episodes, of which 80 (79.2%) had positive results on both tests. The proportion of episodes with a positive urinalysis and culture was similar for those that met (83.3%) and did not meet (78.3%) minimum criteria (P = .06). CONCLUSION: The symptoms and signs necessary to meet minimum criteria to support antimicrobial initiation for UTIs are frequently absent in NH residents with advanced dementia. Antimicrobial therapy is prescribed for the majority of suspected UTIs that do not meet these minimum criteria. Urine specimens are frequently positive regardless of symptoms. These observations underscore the need to reconsider the diagnosis and the initiation of treatment for suspected UTIs in advanced dementia.
OBJECTIVES: To describe the presentation of suspected urinary tract infections (UTIs) in nursing home (NH) residents with advanced dementia and how they align with minimum criteria to justify antimicrobial initiation. DESIGN: Twelve-month prospective study. SETTING: Twenty-five NHs. PARTICIPANTS: Two hundred sixty-six NH residents with advanced dementia. MEASUREMENTS: Charts were abstracted monthly for documentation of suspected UTI episodes to determine whether episodes met minimum criteria to initiate antimicrobial therapy according to consensus guidelines. RESULTS: Seventy-two residents experienced 131 suspected UTI episodes. Presenting symptoms and signs for these episodes are mental status change (44.3%), fever (20.6%), hematuria (6.9%), dysuria (3.8%), costovertebral tenderness (2.3%), urinary frequency (1.5%), rigor (1.5%), urgency (0%), and suprapubic pain (0%). Only 21 (16.0%) episodes met minimal criteria to initiate antimicrobial therapy based on signs and symptoms. Of the 110 episodes that lacked minimum criteria to justify antimicrobial initiation, 82 (74.5%) were treated with antimicrobial therapy. Urinalyses and urine culture results were available for 101 episodes, of which 80 (79.2%) had positive results on both tests. The proportion of episodes with a positive urinalysis and culture was similar for those that met (83.3%) and did not meet (78.3%) minimum criteria (P = .06). CONCLUSION: The symptoms and signs necessary to meet minimum criteria to support antimicrobial initiation for UTIs are frequently absent in NH residents with advanced dementia. Antimicrobial therapy is prescribed for the majority of suspected UTIs that do not meet these minimum criteria. Urine specimens are frequently positive regardless of symptoms. These observations underscore the need to reconsider the diagnosis and the initiation of treatment for suspected UTIs in advanced dementia.
Authors: Nick Daneman; Andrea Gruneir; Alice Newman; Hadas D Fischer; Susan E Bronskill; Paula A Rochon; Geoff M Anderson; Chaim M Bell Journal: J Antimicrob Chemother Date: 2011-09-27 Impact factor: 5.790
Authors: L Wang; B Lansing; K Symons; E L Flannery; J Fisch; K Cherian; S E McNamara; L Mody Journal: Eur J Clin Microbiol Infect Dis Date: 2012-01-25 Impact factor: 3.267
Authors: Lindsay E Nicolle; Suzanne Bradley; Richard Colgan; James C Rice; Anthony Schaeffer; Thomas M Hooton Journal: Clin Infect Dis Date: 2005-02-04 Impact factor: 9.079
Authors: M Loeb; D W Bentley; S Bradley; K Crossley; R Garibaldi; N Gantz; A McGeer; R R Muder; J Mylotte; L E Nicolle; B Nurse; S Paton; A E Simor; P Smith; L Strausbaugh Journal: Infect Control Hosp Epidemiol Date: 2001-02 Impact factor: 3.254
Authors: Mark Loeb; Kevin Brazil; Lynne Lohfeld; Allison McGeer; Andrew Simor; Kurt Stevenson; Stephen Walter; Dick Zoutman Journal: BMC Health Serv Res Date: 2002-09-03 Impact factor: 2.655
Authors: Tessa van der Maaden; Simone A Hendriks; Henrica C W de Vet; Menno T Zomerhuis; Martin Smalbrugge; Elise P Jansma; Raymond T C M Koopmans; Cees M P M Hertogh; Jenny T van der Steen Journal: Drugs Aging Date: 2015-01 Impact factor: 3.923
Authors: Lona Mody; Jennifer Meddings; Barbara S Edson; Sara E McNamara; Barbara W Trautner; Nimalie D Stone; Sarah L Krein; Sanjay Saint Journal: Clin Infect Dis Date: 2015-03-26 Impact factor: 9.079
Authors: Alyssa B Dufour; Michele L Shaffer; Erika M C D'Agata; Daniel Habtemariam; Susan L Mitchell Journal: J Am Geriatr Soc Date: 2015-11-28 Impact factor: 5.562