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      Diagnostic technology: alternative sampling methods for collection of urine specimens in older adults

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          Most cited references 23

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          Urinary tract infection in long-term-care facility residents.

           L Nicolle (2000)
          Urinary tract infection is the most frequent bacterial infection in residents of long-term-care facilities. Most infections are asymptomatic, with a remarkable prevalence of asymptomatic bacteriuria of 15%-50% among all residents. The major reasons for this high prevalence are chronic comorbid illnesses with neurogenic bladder and interventions to manage incontinence. Prospective, randomized, comparative trials of therapy and no therapy for asymptomatic bacteriuria among nursing home residents have repeatedly documented that antimicrobial treatment had no benefits. However, there is substantial diagnostic uncertainty in determining whether an individual with a positive urine culture has symptomatic or asymptomatic infection when there is clinical deterioration and there are no localized findings. In the noncatheterized resident, urinary infection is an infrequent source of fever but may not be definitively excluded. The use of antimicrobials for treatment of urinary infection is part of the larger concern about appropriate antimicrobial use in long-term-care facilities and the impacts of the selective pressure of antimicrobials on colonization and infection with resistant organisms.
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            Urinary infections in the elderly: symptomatic of asymptomatic?

             L Nicolle (1999)
            Asymptomatic bacteriuria is common in the elderly, occurring in as many as 25-50% of elderly nursing home residents. Asymptomatic bacteriuria itself should not be treated with antimicrobial therapy. Difficulties in communication, chronic genitourinary symptoms, and the high frequency of positive urine cultures, make ascertainment of symptomatic infection problematic for the functionally impaired elderly. Chronic genitourinary symptoms are not a manifestation of acute urinary infection, although acute deterioration in symptoms may be consistent with infection. Fever in an institutionalized elderly subject with a positive urine culture and without an indwelling catheter is due to urinary infection in less than 10% of episodes. However, there are no criteria to differentiate urinary infection from other sites in this clinical scenario. Thus, neither urine culture nor clinical presentation allows a diagnosis of symptomatic urinary infection to be made with a high level of certainty. Decisions with respect to antimicrobial therapy must be made on an individual basis and with an understanding of these diagnostic limitations. It is not realistic to expect to optimize antimicrobial usage in this population until issues of diagnostic uncertainty are addressed.
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              Asymptomatic bacteriuria - prevalence in the elderly population.

              To identify the prevalence of asymptomatic bacteriuria in the elderly population and to examine associated risk factors, complications and natural history, and whether treatment improves prognosis. A literature search of MEDLINE, PubMed and the Cochrane Library was undertaken of studies published from 1980 to 2009. A total of 70 articles were identified. Emphasis was given to randomised controlled trials, review articles and more recent publications. Asymptomatic bacteriuria is common in the elderly, especially among institutionalised or hospitalised patients. Risk factors include cognitive impairment, diabetes mellitus, structural urinary tract abnormalities and indwelling catheters. Antimicrobial therapy does not result in improved survival or genitourinary morbidity and may potentially cause avoidable side effects and the emergence of resistant organisms. Bacteriuria is common in functionally impaired elderly patients. In the absence of symptoms or signs of infection, routine dipstick screening and subsequent antimicrobial therapy is not recommended.
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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Family Medicine and Community Health & American Chinese Medical Education Association (USA )
                xxx-xxx
                2305-6983
                June 2013
                May 2014
                : 1
                : 2
                : 43-49
                Affiliations
                1This report was prepared by the Primary Care Diagnostic Horizon Scanning Centre Oxford and the diagnostic research unit of the Academic Center for General Practice (University of Leuven, Belgium)
                Author notes
                CONTACT DETAILS: Dr. Annette Plüddemann horizonscanning@ 123456phc.ox.ac.uk
                Article
                fmch20130207
                10.15212/FMCH.2013.0207
                Copyright © 2013 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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                Self URI (journal page): http://fmch-journal.org/
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                Guideline

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