Prevalence, impact, and management strategies for asymptomatic bacteriuria in the acute care elderly patient: a review of the current literature

Shimoni, Zvi; Cohen, Regev; Froom, Paul

doi:10.1080/14787210.2020.1746642

Cited by 7 publications

(7 citation statements)

References 78 publications

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“…Third, referral practices could influence the proportion of mentally intact patients without local urinary tract symptoms, but would not affect the overall conclusion. Finally, in elderly patients admitted with no source for their fever, it is unclear the proportion of such patients who have a lower urinary tract infection, and this study does not provide guidance when it is safe to watch and wait without upfront antibiotic therapy 12 …”

Section: Discussionmentioning

confidence: 91%

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The influence of mental status on reported local urinary tract symptoms in patients with bacteraemic urinary tract infections

2021

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Aim In elderly patients with a urinary tract infection, the influence of mental status on the frequency of local urinary tract symptoms is uncertain. We aim to compare the frequency of reported local urinary tract symptoms between mentally intact and cognitively impaired older people with a bacteraemic urinary tract infection. Methods We retrospectively selected consecutive patients aged 65 years or older hospitalised in internal medicine departments in a regional hospital from 1 January 2015 to 31 December 2016 if they had identical bacteria isolated from blood and urine cultures. Mentally intact patients were those who were alert on admission and throughout their hospitalisation and without a prior or new diagnosis of dementia. Results Of 222 patients with a bacteraemic urinary tract infection, 125 (56.3%) did not have local urinary tract symptoms, 68.8% (86/125, 95% CI‐60.7%‐76.9%) cognitively impaired, compared with 40.2% (39/97, 95% CI‐30.4%‐50.7%) in those mentally intact (P < .001). Conclusions The absence of local urinary tract symptoms in elderly patients with a bacteraemic urinary tract infection is less frequent but common in those mentally intact, and should not preclude the need for a urine culture or antibiotic therapy.

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Section: Discussionmentioning

confidence: 91%

“…Finally, in elderly patients admitted with no source for their fever, it is unclear the proportion of such patients who have a lower urinary tract infection, and this study does not provide guidance when it is safe to watch and wait without upfront antibiotic therapy. 12…”

Section: Discussionmentioning

confidence: 99%

The influence of mental status on reported local urinary tract symptoms in patients with bacteraemic urinary tract infections

2021

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“…La bacteriuria asintomática es una condición muy común en el adulto mayor, particularmente en los que se encuentran institucionalizados, con una prevalencia de hasta el 50% en los residentes. Esta prevalencia puede variar según sexo, edad, condiciones pre existentes, así como el tipo de institución donde se encuentren (14,15).…”

Section: Epidemiologíaunclassified

“…En el caso de las cistitis, suele presentarse con disuria, frecuencia, urgencia, dolor suprapúbico y hematuria. En el caso de las infecciones de tracto urinario superior, afectan la pelvis y el parénquima renal, los pacientes suelen presentar síntomas adicionales como fiebre, escalofríos, nausea o vómitos y dolor en flanco y lumbar (1,15).…”

Section: Infección En La Comunidadunclassified

Infección urinaria en el adulto mayor

2022

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La infección del tracto urinario corresponde a la localización más común de patología infecciosa en el adulto mayor. Puede presentarse de manera recurrente, es decir tres o más episodios sintomáticos en un periodo de un año, o más de dos infecciones en 6 meses, la misma puede presentarse de manera no complicada o complicada, este último tipo suele presentarse en personas con anormalidades funcionales o estructurales y afecta principalmente al tracto urinario superior. En el adulto mayor existe gran prevalencia de síntomas urinarios (incontinencia, urgencia, frecuencia, nicturia), los cuáles no siempre están en relación con una infección. Por lo que se debe distinguir los cambios fisiológicos asociados al envejecimiento de las alteraciones patológicas. Para lograr un adecuado diagnóstico, es mandatorio realizar una historia clínica detallada, que incluya de ser posible información brindada por el paciente y el cuidador, también se debe llevar a cabo un examen físico y solicitar laboratorios de manera prudente, es decir únicamente en caso de que se presenten síntomas clínicos sugestivos, ya que los exámenes por sí solos no son capaces de diferenciar una bacteriuria asintomática de una infección urinaria. La bacteriuria asintomática no debe ser tamizada ni tratada en el adulto mayor. En caso de indicar tratamiento, debe realizarse de manera precavida, ya que brindar terapias innecesarias provocan resistencia microbiana, sin lograr ningún beneficio en la supervivencia.

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“…Inappropriate antibiotic use for UTIs is of particular concern. For example, inappropriate treatment of asymptomatic bacteriuria (ASB), which is present in up to 16.5% of healthy women can lead to negative outcomes and increase costs [ 6 – 8 ]. The last decade has also seen an increase in frequency of resistance to common antibiotics when treating outpatient UTIs and multidrug-resistant infections are becoming more commonplace, making these infections more difficult to treat [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

A qualitative analysis of diagnostic testing, antibiotic selection, and quality improvement interventions for uncomplicated urinary tract infections

et al. 2020

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Background Uncomplicated urinary tract infections (UTIs) can often be diagnosed based solely on symptoms and should be treated with a short course of narrow spectrum antibiotics. However, clinicians often order urine analyses and prescribe long courses of broad spectrum antibiotics. Objective The objectives of our study are: 1) Understand how primary care providers and residents clinically approach UTIs and 2) to understand specific opportunities, based on provider type, to target future antibiotic stewardship interventions. Design and participants We conducted semi-structured qualitative interviews of community primary care providers (n = 15) and internal medicine residents (n = 15) in St. Louis, Missouri from 2018-2019. A 5point Likert scale was used to evaluate participant preferences for possible interventions. Interviews were transcribed, de-identified, and coded by two independent researchers using a combination inductive and deductive approach. Key results Several common themes emerged. Both providers and residents ordered urine tests to "confirm" presence of urinary tract infections. Antibiotic prescription decisions were often based on historical practice and anecdotal experience rather than local susceptibility data or clinical practice guidelines. Community providers were more comfortable treating patients over the phone than residents and tended to prescribe longer courses of antibiotics. Both community providers and residents voiced frustrations with guidelines being difficult to

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Prevalence, impact, and management strategies for asymptomatic bacteriuria in the acute care elderly patient: a review of the current literature

Cited by 7 publications

References 78 publications

The influence of mental status on reported local urinary tract symptoms in patients with bacteraemic urinary tract infections

The influence of mental status on reported local urinary tract symptoms in patients with bacteraemic urinary tract infections

Infección urinaria en el adulto mayor

A qualitative analysis of diagnostic testing, antibiotic selection, and quality improvement interventions for uncomplicated urinary tract infections

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