Urinary tract infection in long-term care facilities

Lindsay E. Nicolle

doi:10.1071/HI13043

REVIEW (Open Access)

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Urinary tract infection in long-term care facilities

Lindsay E. Nicolle

+ Author Affiliations

- Author Affiliations

Department of Internal Medicine and Medical Microbiology, University of Manitoba, Winnipeg, MB R3A 1R9, Canada. Email: lnicolle@hsc.mb.ca

Healthcare Infection 19(1) 4-12 https://doi.org/10.1071/HI13043
Submitted: 13 November 2013 Accepted: 28 November 2013 Published: 17 December 2013

Journal Compilation © Australasian College for Infection Prevention and Control 2014

Abstract

Introduction: Asymptomatic bacteriuria and pyuria are pervasive in the long-term care population. Optimal management of urinary infection for residents of long-term care facilities requires knowledge of the unique features of the infection in this setting, together with critical evaluation of each episode of potential urinary infection in the individual resident.

Method: A non-structured review of current knowledge and recommendations relevant to urinary infection in long-term care facilities.

Results: Urinary infection is the second most common infection occurring in long-term care facility residents. For residents without chronic indwelling catheters, acute, localising, genitourinary symptoms should be present to support a clinical diagnosis of symptomatic infection. Inappropriate antimicrobial use for urinary tract infection, particularly treatment of asymptomatic bacteriuria and prophylaxis of urinary infection, is a consistent observation in reviews of antimicrobial use in these facilities. Management approaches to improve treatment include observation and reassessment when symptoms are questionable or the diagnosis is unclear, limiting the use of chronic indwelling catheters, and early identification of complications, such as obstruction, of indwelling catheters.

Conclusions: Clinical diagnostic imprecision and a high prevalence of asymptomatic bacteriuria means these infections are overdiagnosed and overtreated, leading to adverse events from excess antimicrobial use. Antimicrobial stewardship programs to improve antimicrobial use for this indication need to be developed in long-term care facilities.

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