Bacteriuria and urinary incontinence in aged female nursing home residents

Abstract

Although urinary incontinence (UI) is identified as a symptom of urinary tract infection (UTI), the incontinent elderly frequently are not treated for UTI unless clinically significant manifestations are present. The purpose of this research was to identify variables that may be associated with bacteriuria in the female person who is already known to be incontinent. A sample of 65 incontinent female nursing home residents was divided into three groups: (1) those with negative urine screens; (2) those with a bacterial count of over 100,000 per ml of urine; and (3) those with a bacterial count of below 100,000 per ml urine. Variables examined were: (1) physical symptoms; (2) physical examination findings; (3) mental status; and (4) functional abilities. Significant group differences were found regarding awareness of the urge to void and ability to hold urine. A near significance finding suggested that the higher the level of cognitive function the less likely the presence of UTI. There was some evidence to suggest the higher the level of independence the less likely the presence of UTI. Recommendations for nursing practice and future nursing research are made.

Diagnostic value of symptoms and signs for identifying urinary tract infection in older adult outpatients: Systematic review and meta-analysis

“…Four were cohort studies 24 , 25 , 26 , 27 and the rest were cross-sectional. 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 Nine studies were conducted in Europe 24 , 28 , 29 , 30 , 31 , 32 , 33 , 36 , 37 and six in North America. 25 , 26 , 27 , 34 , 35 , 38 Locations included nursing homes (six studies), residential care facilities (one study), long-term care facilities (one study), participants’ homes (three studies) and combinations of the aforementioned settings (four studies).…”

“…Only 17 of the 39 UTI cases had tests; 14 had a dipstick, 3 had a culture Juthani-Mehta et al (2009) USA 26 Cohort Nursing homes 551 > 65 2 years Urine culture (Defined as bacteriuria of > 100,000 CFU plus pyuria defined as > 10 WBCs) combined with urinalysis Lara et al (1990) USA 27 Cohort Nursing home care unit 99 Unclear N/A Bacteriuria (over 100,000 bacterial colony count/ml) - clean-catch of catheterized urine specimens Magaziner et al (1991) USA 34 Cross-sectional Long term care facilities/ Nursing homes 4259 >65 N/A A combination of symptoms/signs/lab investigations. Not all patients had a urine culture Midthun et al (2004) USA 35 Cross-sectional Nursing homes 97 64–102 N/A Two different definitions used: Bacteriuria alone (≥ 50,000 CFU/ml growth of a single organism) or Bacteriuria and Pyuria (> 10 WBCs/hpf) Sourander et al (1965) Finland 36 Cross-sectional Recruited from home setting, examinations performed in outpatient department of the Municipal Hospital of Turku 481 ≥65 N/A Growth > 10^5 bacteria/ml in clean voided urine Sundvall et al (2014) Sweden 37 Cross-sectional Nursing homes 421 63–100 N/A Urine culture of ≥ 10^5 CFU/ml OR ≥ 10^3 if E.coli growth or in male patients with Klebsiella/enterococcus faecalis OR ≥ 10^4 in women growing Klebsiella/enterococcus faecalis Whippo et al (1989) USA 38 Cross-sectional Nursing homes 65 64–97 N/A Urine culture > 100,000 bacteria/ml urine …”

Systematic review of nursing management of urinary tract infections in the cognitively impaired elderly client in residential care: Is there a hole in holistic care?

“…A review of expert reports produces a composite picture of the disease processes and conditions, which assist in further prediction of a client's potential for urinary tract infection (Table 3). 3,11,12 …”

“…Composite indicators of self‐care deficits that could promote urinary tract infection can be gleaned from studies 3,9,11 . These indicators are instrumental in bringing together a bigger picture regarding clients' propensities for infection but that currently demonstrate a low level of evidence (Table 4).…”

A Pilot Study

“…Approximately 41%Y65% of nursing home residents with UI also have bacteriuria or urinary tract infections (UTIs; Hedin, Petersson, Widebäck, Kahlmeter, & Molstad, 2002;Omli et al, 2010;Whippo & Creason, 1989). Approximately 41%Y65% of nursing home residents with UI also have bacteriuria or urinary tract infections (UTIs; Hedin, Petersson, Widebäck, Kahlmeter, & Molstad, 2002;Omli et al, 2010;Whippo & Creason, 1989).…”