Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-28T03:33:00.331Z Has data issue: false hasContentIssue false

Urinary Tract Infections in Long-Term–Care Facilities

Published online by Cambridge University Press:  02 January 2015

Lindsay E. Nicolle*
Affiliation:
Health Sciences Centre, Department of Medicine, Winnipeg, Manitoba, Canada
*
Health Sciences Centre, Department of Medicine, GC430-820 Sherbrook St, Winnipeg, MB R3A 1R9, Canada

Abstract

Urinary tract infection (UTI) is the most common bacterial infection occurring in residents of long-term–care facilities. It is a frequent reason for antimicrobial administration, but antimicrobial use for treating UTIs is often inappropriate. Achieving optimal management of UTI in this population is problematic because of the very high prevalence of bacteriuria, evidence that the treatment of asymptomatic bacteriuria is not beneficial, and the clinical and microbiological imprecision in diagnosing symptomatic UTI. This position paper has been developed, using available evidence, to assist facilities and healthcare professionals in managing this common problem.

Type
SHEA Position Paper
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Members of the SHEA Long-Term–Care Committee include Philip Smith, MD; Lauri Thrupp, MD; Kent Crossley, MD; Larry J. Strausbaugh, MD; Suzanne Bradley, MD; R. Brooks-Gainer, MD; Nelson Gantz, MD; Andrew E. Simor, MD; Sky Blue, MD; Carol Freer, MD

References

1. Gross, PA, Barrett, TI, Dellinger, EP, Krause, PJ, Martone, WJ, McGowan, JE Jr et al. Consensus development of quality standards. Infect Control Hosp Epidemiol 1994;15:180181.Google Scholar
2. Rubin, RH, Shapiro, ED, Andriole, VT, Davis, RJ, Stamm, WE. Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Clin Infect Dis 1992;15(suppl 1):S216S227.Google Scholar
3. Nicolle, LE. Asymptomatic bacteriuria in the elderly. Infect Dis Clin North Am 1997;11:647662.Google Scholar
4. Nicolle, LE, Strausbaugh, LJ, Garibaldi, RA. Infections and antibiotic resistance in nursing homes. Clin Microbiol Rev 1996;9:117.Google Scholar
5. Nicolle, LE, Henderson, E, Bjornson, J, McIntyre, M, Harding, GKM, MacDonell, JA. The association of bacteriuria with resident characteristics and survival in elderly institutionalized men. Ann Intern Med 1987;106:682686.CrossRefGoogle ScholarPubMed
6. Boscia, JA, Kobasa, WD, Knight, RA, Abrutyn, E, Levison, ME, Kaye, D. Epidemiology of bacteriuria in an elderly ambulatory population. Am J Med 1986;80:208214.CrossRefGoogle Scholar
7. Brocklehurst, JC, Bee, P, Jones, D, Palmer, MK. Bacteriuria in geriatric hospital patients: its correlates and management. Age Aging 1977;6:240245.CrossRefGoogle ScholarPubMed
8. Monane, M, Gurwitz, JH, Lipsitz, LA, Glynn, RJ, Choodnovskiy, I, Avorn, J. Epidemiologic and diagnostic aspects of bacteriuria: a longitudinal study in older women. J Am Geriatr Soc 1995;43:618622.Google Scholar
9. Nicolle, LE, Mayhew, JW, Bryan, L. Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized women. Am J Med 1987;83:2733.Google Scholar
10. Nicolle, LE, Bjornson, J, Harding, GKM, MacDonell, JA. Bacteriuria in elderly institutionalized men. N Engl J Med 1983;309:14201426.CrossRefGoogle ScholarPubMed
11. Kasviki-Charvati, P, Drolette-Kefakis, B, Papanayiotou, PC, Dontas, AS. Turnover of bacteriuria in old age. Age Aging 1982;11:169174.CrossRefGoogle ScholarPubMed
12. Abrutyn, E, Mossey, J, Levison, M, Boscia, J, Pitsakis, P, Kaye, D. Epidemiology of asymptomatic bacteriuria in elderly women. J Am Geriatr Soc 1991;39:388393.Google Scholar
13. Boscia, JA, Kobasa, WD, Knight, RA, Abrutyn, E, Levison, ME, Kaye, D. Therapy vs no therapy for bacteriuria in elderly ambulatory nonhospitalized women. JAMA 1986;257:10671071.CrossRefGoogle Scholar
14. Ouslander, JG, Greengold, B, Chen, S. External catheter use and urinary tract infections among incontinent male nursing home patients. J Am Geriatr Soc 1987;35:10631070.Google Scholar
15. Lipsky, BA. Urinary tract infections in men: epidemiology, pathophysiology, diagnosis, and treatment. Ann Intern Med 1989;110:138150.Google Scholar
16. Hirsh, DD, Fainstein, V, Musher, DM. Do condom catheter collecting systems cause urinary tract infection? JAMA 1979;242:340341.Google Scholar
17. Johnson, ET. The condom catheter: urinary tract infection and other complications. South Med J 1983;76:579582.CrossRefGoogle ScholarPubMed
18. Raz, R, Stamm, W. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med 1993;329:753758.CrossRefGoogle ScholarPubMed
19. Stamm, WE, Raz, R. Factors contributing to susceptibility of postmenopausal women to recurrent urinary tract infection. Clin Infect Dis 1999;28:723725.Google Scholar
20. Tronetti, PS, Gracely, EJ, Boscia, JA. Lack of association between medication use and the presence or absence of bacteriuria in elderly women. J Am Geriatr Soc 1990;38:11991202.Google Scholar
21. Alvarez, S, Shell, C, Woolley, T, Berk, S, Smith, J. Nosocomial infections in long term care facilities. J Gerontol 1988;43(suppl 1):M9M17.CrossRefGoogle Scholar
22. Strausbaugh, LJ, Crossley, KB, Nurse, BA, Thrupp, LD, SHEA Long-Term–Care Committee. Antimicrobial resistance in long-term–care facilities. Infect Control Hosp Epidemiol 1996;17:129140.CrossRefGoogle Scholar
23. Fierer, J, Ekstrom, M. An outbreak of Providencia stuartii urinary tract infections: patients with condom catheters are a reservoir of the bacteria. JAMA 1981;245:15531555.Google Scholar
24. Standfast, SJ, Michelsen, PB, Baltch, AL, Smith, RP, Latham, EK, Spellacy, AB, et al. A prevalence survey of infections in a combined acute and long-term care hospital. Infect Control 1984;5:177184.Google Scholar
25. Suntharalingan, M, Seth, V, Moore-Smith, B. Site of urinary tract infection in elderly women admitted to an acute geriatric assessment unit. Age Aging 1983;12:317322.CrossRefGoogle Scholar
26. Nicolle, LE, Muir, P, Harding, GKM, Norris, M. Localization of site of urinary infection in elderly institutionalized women with asymptomatic bacteriuria. J Infect Dis 1988;157:6570.CrossRefGoogle ScholarPubMed
27. Boscia, AJ, Abrutyn, E, Levison, ME, Pitsakis, PG, Kaye, D. Pyuria and asymptomatic bacteriuria in elderly ambulatory women. Ann Intern Med 1989;110:404405.Google Scholar
28. Rodgers, K, Nicolle, LE, McIntyre, M, Harding, GKM, Hoban, D, Murray, D. Pyuria in institutionalized elderly subjects. Can J Infect Dis 1991;2:142146.Google ScholarPubMed
29. Nicolle, LE, Brunka, J, Orr, P, Wilkins, J, Harding, GKM. Urinary immunoreactive interleukin-1 alpha and interleukin-6 in bacteriuric institutionalized elderly subjects. J Urol 1993;149:10491053.CrossRefGoogle ScholarPubMed
30. Nicolle, LE, Brunka, J. Urinary IgG and IgA antibodies in elderly institutionalized subjects with bacteriuria. Gerontology 1990;36:345355.Google Scholar
31. Nicolle, LE, Duckworth, H, Brunka, J, Urias, B, Kennedy, J, Murray, D, et al. Urinary antibody level and survival in bacteriuric institutionalized elderly subjects. J Am Geriatr Soc 1998;46:947953.CrossRefGoogle Scholar
32. Nicolle, LE, Brunka, J, McIntyre, M, Murray, D, Harding, GKM. Asymptomatic bacteriuria, urinary antibody, and survival in the institutionalized elderly. J Am Geriatr Soc 1992;40:607613.CrossRefGoogle ScholarPubMed
33. Abrutyn, E, Mossey, J, Berlin, JA, Boscia, J, Levison, M, Pitsakis, P, et al. Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women. Ann Intern Med 1994;120:827833.Google Scholar
34. Orr, P, Nicolle, LE, Duckworth, H, Brunka, J, Kennedy, J, Murray, D, et al. Febrile urinary infection in the institutionalized elderly. Am J Med 1996;100:7177.CrossRefGoogle ScholarPubMed
35. Muder, RR, Brennen, C, Wagener, MM, Goetz, AM. Bacteremia in a long term care facility: a five-year prospective study of 163 consecutive episodes. Clin Infect Dis 1992;14:647654.Google Scholar
36. Nicolle, LE, McIntyre, M, Hoban, D, Murray, D. Bacteremia in a long term care facility. Can J Infect Dis 1994;5:130132.Google Scholar
37. Irvine, PW, van Buren, N, Crossley, K. Causes for hospitalization of nursing home residents: the role of infection. J Am Geriatr Soc 1984;32:103107.Google Scholar
38. Brooks, S, Warshaw, G, Hasse, L, Kues, JR. The physician decision-making process in transferring nursing home patients to the hospital. Arch Intern Med 1994;154:902908.CrossRefGoogle ScholarPubMed
39. Rudman, D, Hontanosas, A, Cohen, Z, Mattson, DE. Clinical correlates of bacteremia in a Veteran's Administration extended care facility. J Am Geriatr Soc 1988;36:726732.CrossRefGoogle Scholar
40. Nicolle, LE, McIntyre, M, Zacharias, H, MacDonell, J. Twelve month surveillance of infections in institutionalized elderly men. J Am Geriatr Soc 1984;32:513519.Google Scholar
41. Gross, JS, Neufeld, RR, Libow, LS, Gerber, I, Rodstein, M. Autopsy study of the elderly institutionalized patient. Arch Intern Med 1988;148:173176.Google Scholar
42. Wayne, SJ, Rhyne, RL, Stratton, M. Longitudinal prescribing patterns in a nursing home population. J Am Geriatr Soc 1992;40:5356.CrossRefGoogle Scholar
43. Crossley, K, Henry, K, Irivine, P, Willenbring, K. Antibiotic use in nursing homes: prevalence, cost, and utilization review. Bull NY Acad Med 1987;63:510518.Google ScholarPubMed
44. Warren, JW, Palumbo, FB, Fitterman, L, Speedie, SM. Incidence and characteristics of antibiotic use in aged nursing home patients. J Am Geriatr Soc 1991;39:963972.Google Scholar
45. Zimmer, JG, Bentley, DW, Valenti, WM, Watson, NM. Systemic antibiotic use in nursing homes. A quality assessment. J Am Geriatr Soc 1986;34:703710.Google Scholar
46. Katz, PR, Beam, TR, Brand, F, Boyce, K. Antibiotic use in the nursing home physician practice patterns. Arch Intern Med 1990;150:14651468.CrossRefGoogle ScholarPubMed
47. Montgomery, P, Semenchuk, M, Nicolle, LE. Antimicrobial use in nursing homes in Manitoba. J Geriatr Drug Ther 1995;9:5574.CrossRefGoogle Scholar
48. Nicolle, LE. Urinary tract infections in the elderly: symptomatic or asymptomatic? Int J Antimicrob Agents 1999;11:265268.Google Scholar
49. Ouslander, JG, Shapira, M, Schnelle, JF, Uman, G, Finegold, S, Tuico, E, et al. Does eradication of bacteriuria affect the severity of chronic urinary incontinence in nursing home residents? Ann Intern Med 1995;122:749754.CrossRefGoogle ScholarPubMed
50. Brocklehurst, JC, Dillane, JB, Griffiths, L, Fry, J. The prevalence and symptomatology of urinary infection in an aged population. Geront Clin 1968;10:242253.CrossRefGoogle Scholar
51. Boscia, JA, Kobasa, WD, Abrutyn, E, Levison, ME, Kaplan, AM, Kaye, D. Lack of association between bacteriuria and symptoms in the elderly. Am J Med 1986;81:979982.Google Scholar
52. Nicolle, LE, Orr, P, Duckworth, H, Brunka, J, Kennedy, J, Murray, D, et al. Gross hematuria in residents in long term care facilities. Am J Med 1993;94:611618.Google Scholar
53. Berman, P, Hogan, B, Fox, RA. The atypical presentation of infection in old age. Age Aging 1987;16:201207.Google Scholar
54. Nicolle, LE. Consequences of asymptomatic bacteriuria in the elderly. Int J Antimicrob Agents 1994;4:107111.Google Scholar
55. Ouslander, JG, Greengold, BA, Silverblatt, FJ, Garcia, JP. An accurate method to obtain urine for culture in men with external catheters. Arch Intern Med 1987;147:286288.CrossRefGoogle ScholarPubMed
56. Nicolle, LE, Harding, GKM, Kennedy, J, McIntyre, M, Aoki, F, Murray, D. Urine specimen collection with external devices for diagnosis of bacteriuria in elderly incontinent men. J Clin Microbiol 1988;26:11151119.CrossRefGoogle ScholarPubMed
57. Ouslander, JG, Schapira, M, Schnelle, JF. Urine specimen collection from incontinent female nursing home residents. J Am Geriatr Soc 1995;43:2,79281.Google Scholar
58. Belmin, J, Hervias, Y, Avellano, E, Oudart, O, Durand, I. Reliability of sampling urine from disposable diapers in elderly incontinent women. J Am Geriatr Soc 1993;41:11821186.Google Scholar
59. Michielssen, WJS, Geurs, FJC, Verschraegen, LC, Claeys, GW, Afschrift, MB. A simple and efficient urine sampling method for bacteriological examination in elderly women. Age Aging 1997;26:493495.Google Scholar
60. Ouslander, JG, Schapira, M, Finegold, S, Schnelle, J. Accuracy of rapid urine screening tests among incontinent nursing home residents with asymptomatic bacteriuria. J Am Geriatr Soc 1995;43:772775.CrossRefGoogle ScholarPubMed
61. Avorn, J, Monane, M, Gurwitz, JH, Glynn, RJ, Choodnovsky, I, Lipsitz, LA. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA 1994;271:751754.Google Scholar
62. Cardozo, L, Bennes, C, Abbott, D. Low dose oestrogen prophylaxis for recurrent urinary tract infections in elderly women. Br J Obstet Gynaecol 1998;105:403404.Google Scholar
63. Terpenning, MS, Allada, R, Kauffman, CA. Intermittent urethral catheterization in the elderly. J Am Geriatr Soc 1989;37:411416.CrossRefGoogle ScholarPubMed
64. Duffy, LM, Cleary, J, Ahern, S, Kuskowski, MA, West, M, Wheeler, L, et al. Clean intermittent catheterization: safe, cost-effective bladder management for male residents of VA nursing homes. J Am Geriatr Soc 1995;43:865870.Google Scholar
65. Cafferkey, MT, Falkiner, FR, Gillespie, WA, Murphy, DM. Antibiotics for the prevention of septicaemia in urology. J Antimicrob Chemother 1982;9:471477.Google Scholar
66. Nicolle, LE, Mayhew, JW, Bryan, L. Outcome following antimicrobial therapy for asymptomatic bacteriuria in elderly women resident in an institution. Age Aging 1988;17:187192.CrossRefGoogle ScholarPubMed
67. Nicolle, LE, Bentley, D, Garibaldi, R, Neuhaus, E, Smith, P, SHEA Long-Term–Care Committee. Antimicrobial use in long-term–care facilities. Infect Control Hosp Epidemiol 1996;17:119128.CrossRefGoogle Scholar
68. Harding, GKM, Nicolle, LE, Ronald, AR, Preiksaitas, JK, Forward, KR, Low, DE, et al. Management of catheter acquired urinary tract infection in women. Therapy following catheter removal. Ann Intern Med 1991;114:713719.Google Scholar
69. Saginur, R, Nicolle, LE, the Canadian Infectious Diseases Society Clinical Trials Study Group. Single dose compared with three days norfloxacin for treatment of uncomplicated urinary infection in women. Arch Intern Med 1992;152:12331237.CrossRefGoogle Scholar
70. Gleckman, R, Crowley, M, Natsios, GA. Therapy of recurrent invasive urinary tract infections of men. N Engl J Med 1979;301:878880.Google Scholar
71. Smith, JW, Jones, SR, Reed, WP, Tice, AD, Deupree, RH, Kaijser, B. Recurrent urinary tract infections in men. Ann Intern Med 1979;91:544548.Google Scholar
72. Warren, JL, Steinberg, R, Hebel, JR, Tenney, J. The prevalence of urethral catheterization in Maryland Nursing Homes. Arch Intern Med 1989;149:15351537.CrossRefGoogle ScholarPubMed
73. Kunin, CM, Douthitt, S, Dancing, J, Anderson, J, Moeschberger, M. The association between the use of urinary catheters and morbidity and mortality among elderly patients in nursing homes. Am J Epidemiol 1992;135:291301.Google Scholar
74. Warren, JW. Catheter-associated bacteriuria. Clin Geriatr Med 1992;8:805819.Google Scholar
75. Warren, JW, Tenney, JH, Hoopes, JM, Muncie, HL, Anthony, WC. A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 1982;146:719723.Google Scholar
76. Cox, AJ, Hukins, DWL, Sutton, TM. Infection of catheterized patients: bacterial colonization of encrusted Foley catheters shown by scanning electron microscopy. Urol Res 1989;17:349352.Google Scholar
77. Grahn, D, Norman, DC, White, ML, Cantrell, M, Yoshikawa, TT. Validity of urine catheter specimens for diagnosis of urinary tract infection in the elderly. Arch Intern Med 1985;145:18581860.Google Scholar
78. Tenney, JH, Warren, JW. Bacteriuria in women with long term catheters: paired comparison of indwelling and replacement catheters. J Infect Dis 1988;157:199202.Google Scholar
79. Warren, JW, Damron, D, Tenney, JH, Hoopes, JM, Deforge, B, Muncie, HL Jr Fever, bacteremia, and death as complications of bacteriuria in women with long term urethral catheters. J Infect Dis 1987;155:11511158.Google Scholar
80. Kunin, CM. Blockage of urinary catheters: role of microorganisms and constituents of the urine on formation of encrustations. J Clin Epidemiol 1989;42:835842.Google Scholar
81. Warren, JW, Munci, HL Jr Hall-Graggs, M. Acute pyelonephritis associated with bacteriuria during long-term catheterization. A prospective clinicopathological study. J Infect Dis 1988;158:13411346.CrossRefGoogle ScholarPubMed
82. Steward, DK, Wood, GL, Cohen, RL, Smith, JW, Mackowiak, PA. Failure of the urinalysis and quantitative urine culture in diagnosing symptomatic urinary tract infections in patients with long-term urinary catheters. Am J Infect Control 1985;13:154160.CrossRefGoogle ScholarPubMed
83. Muncie, HL, Hoopes, JM, Damron, DJ, Tenney, JH, Warren, JW. Once daily irrigation of long term urethral catheters with normal saline. Arch Intern Med 1989;149:441443.Google Scholar
84. Raz, R, Schiller, D, Nicolle, LE. Does replacement of catheter improve the outcome of patients with permanent urinary catheter and symptomatic bacteriuria. J Urol 2000;164:12541258.CrossRefGoogle Scholar
85. Hoffman, N, Jenkens, R, Putney, K. Nosocomial infection rates during a one year period in a nursing home care unit of a Veteran's Administration hospital. Am J Infect Control 1990;18:5563.Google Scholar
86. Alvarez, S, Shell, CG, Woolley, TW, Berk, SL, Smith, JK. Nosocomial infections in long-term facilities. J Gerontol 1988;43:917.Google Scholar
87. Jackson, MM, Fierer, J, Barrett-Connor, E, Fraser, D, Klarsber, MR, Hatch, R, et al. Intensive surveillance for infections in a three-year study of nursing home patients. Am J Epidemiol 1992;135:685696.CrossRefGoogle Scholar
88. Darnowski, SB, Gordon, M, Simor, AE. Two years of infection surveillance in a geriatric long-term care facility. Am J Infect Control 1991;19:185190.CrossRefGoogle Scholar
89. Scheckler, WE, Peterson, PJ. Infections and infection-control among residents of eight rural Wisconsin nursing homes. Arch Intern Med 1986;146:19811984.Google Scholar
90. Strausbaugh, LJ, Jacobson, C. Incidence and impact of infection in a nursing home care unit. Am J Infect Control 1990;18:151159.Google Scholar