Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals: a cross-sectional study of 32 nursing homes

Abstract

BackgroundThe high prevalence of bacteriuria in elderly individuals makes it difficult to know if a new symptom is related to bacteria in the urine. There are different views concerning this relationship and bacteriuria often leads to antibiotic treatments. The aim of this study was to investigate the relationship between bacteria in the urine and new or increased restlessness, fatigue, confusion, aggressiveness, not being herself/himself, dysuria, urgency and fever in individuals at nursing homes for elderly when statistically considering the high prevalence of asymptomatic bacteriuria in this population.MethodsIn this cross-sectional study symptoms were registered and voided urine specimens were collected for urinary cultures from 651 elderly individuals. Logistic regressions were performed to evaluate the statistical correlation between bacteriuria and presence of a symptom at group level. To estimate the clinical relevance of statistical correlations at group level positive and negative etiological predictive values (EPV) were calculated.ResultsLogistic regression indicated some correlations at group level. Aside from Escherichia coli in the urine and not being herself/himself existing at least one month, but less than three months, EPV indicated no clinically useful correlation between any symptoms in this study and findings of bacteriuria.ConclusionsUrinary cultures provide little or no useful information when evaluating diffuse symptoms among elderly residents of nursing homes. Either common urinary tract pathogens are irrelevant, or urine culture is an inappropriate test.

Bacteruria and Urinary Tract Infections in the Elderly

“…One study found enterobacteriaceae species to account for 34.8% of remaining cultures, while the second distributed these between Klebsiella (12%) and Enterococcus faecalis (8%). 21,22 Other common hospitalassociated pathogens like Pseudomonas aeruginosa, vancomycin-resistant enterococci, and Candida spp have been identified in this population as well. 23 Patients with indwelling catheters are uniquely at higher risk for biofilm-associated organisms, polymicrobial infections, and yeast colonization and infection.…”

Diagnosis and Management of Urinary Tract Infection in Older Adults

“…was the second most common (12%) followed by Enterococcus faecalis (8%). 20 It is postulated that the postmenopausal state, worsening incontinence and disability, and greater exposure to antibiotics changes the vaginal microbiome of older women, thereby changing the profile of uropathogens causing UTI in community-dwelling and institutionalized women. Fig.…”

“…Thus, in most cases urinary culture should not be obtained in cases of a negative dipstick for leukocyte esterase and nitrite, and causes other than UTI should be evaluated. Urine culture alone often is not helpful in evaluating diffuse nonspecific symptoms in older long-term care residents 20 and should not be performed routinely in asymptomatic patients. 1 Fig.…”

Antimicrobial Stewardship Strategies in Nursing Homes: Urinary Tract Infections

“…The most common sign reported for UTIs is altered mental status which includes symptoms such as Bconfused, more irritable, crying, aggressive, agitated, and less compliant^ [26]. Also, Sundvall et al found no correlations between UTI symptoms and bacteriuria among 651 nursing home residents [27]. The lack of specificity of these symptoms can create challenges with diagnosing UTIs.…”