Diagnosing probable urinary tract infections in nursing home residents without indwelling catheters: a narrative review

Overdiagnosis of urinary tract infections (UTIs) is one of the most common reasons for the unnecessary use of antibiotics in nursing homes, increasing the risk of missing serious conditions. Various decision tools and algorithms aim to aid in UTI diagnosis and the initiation of antibiotic therapy fo...

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Published inClinical microbiology and infection Vol. 30; no. 12; pp. 1523 - 1528
Main Authors Llor, Carl, Moragas, Ana, Ruppe, Georg, Lykkegaard, Jesper, Hansen, Malene Plejdrup, Antsupova, Valeria S., Jensen, Jette Nygaard, Theut, Anna Marie, Petek, Davorina, Sodja, Nina, Kowalczyk, Anna, Bjerrum, Lars, Bjerrum, Anders, García-Sangenís, Ana, Modena, Daniela, Monfà, Ramon, Morros Pedrós, Rosa, Chalkidou, Athina, Marloth, Tina, Døssing Berntsen, Susanne, Døssing-Poulsen, Nina Camilla, Munck, Anders, Kanstrup Olsen, Jonas, Tang Hall, Asbjørn, López-Valcárcel, Beatriz González, Squaglia, Ana, Elistratova, Marina, Vallejo-Torres, Laura, Anastasaki, Marilena, Angelaki, Agapi, Karkana, Maria-Nefeli, Lionis, Christos, Petelos, Elena, Tsoulchai, Greta, Balint, András, Benkő, Ria, Álvarez, Laura, Briones, Sergi, Ricart, Marta, Godycki-Cwirko, Maciej, Glasa, Jozef, Glasová, Helena, Jaruseviciene, Lina, Radzeviciene, Ruta
Format Journal Article
LanguageEnglish
Published England Elsevier Ltd 01.12.2024
Subjects
Algorithms
Anti-Bacterial Agents - therapeutic use
Antibiotic prescribing
Bacteriuria
Bacteriuria - diagnosis
Catheters, Indwelling - adverse effects
Frail elderly
Humans
Nursing Homes
Prevalence
Signs and symptoms
Urinalysis
Urinary tract infection
Urinary Tract Infections - diagnosis
Nursing homes
Signs and symptoms
Urinary tract infection
Frail elderly
Bacteriuria
Urinalysis
Antibiotic prescribing
Online AccessGet full text
ISSN1198-743X
1469-0691
1469-0691
DOI10.1016/j.cmi.2024.08.020

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Abstract Overdiagnosis of urinary tract infections (UTIs) is one of the most common reasons for the unnecessary use of antibiotics in nursing homes, increasing the risk of missing serious conditions. Various decision tools and algorithms aim to aid in UTI diagnosis and the initiation of antibiotic therapy for residents. However, due to the lack of a clear reference standard, these tools vary widely and can be complex, with some requiring urine testing. As part of the European-funded IMAGINE project, aimed at improving antibiotic use for UTIs in nursing home residents, we have reviewed the recommendations. This review provides a comprehensive summary of the more relevant tools and algorithms aimed at identifying true UTIs among residents living in nursing homes and discusses the challenges in using these algorithms based on updated research. The discussion is based on a relevant medical literature search and synthesis of the findings and published tools to provide an overview of the current state of improving the diagnosis of UTIs in nursing homes. The following topics are covered: prevalence of asymptomatic bacteriuria, diagnostic challenges, clinical criteria, urinary testing, and algorithms to be implemented in nursing home facilities. Diagnosing UTIs in residents is challenging due to the high prevalence of asymptomatic bacteriuria and nonspecific urinary tract signs and symptoms among those with suspected UTIs. The fear of missing a UTI and the perceived antibiotic demands from residents and relatives might lead to overdiagnosis of this common condition. Despite their widespread use, urine dipsticks should not be recommended for geriatric patients. Patients who do not meet the minimum diagnostic criteria for UTIs should be evaluated for alternative conditions. Adherence to a simple algorithm can prevent unnecessary antibiotic courses without compromising resident safety.
AbstractList Overdiagnosis of urinary tract infections (UTIs) is one of the most common reasons for the unnecessary use of antibiotics in nursing homes, increasing the risk of missing serious conditions. Various decision tools and algorithms aim to aid in UTI diagnosis and the initiation of antibiotic therapy for residents. However, due to the lack of a clear reference standard, these tools vary widely and can be complex, with some requiring urine testing. As part of the European-funded IMAGINE project, aimed at improving antibiotic use for UTIs in nursing home residents, we have reviewed the recommendations. This review provides a comprehensive summary of the more relevant tools and algorithms aimed at identifying true UTIs among residents living in nursing homes and discusses the challenges in using these algorithms based on updated research. The discussion is based on a relevant medical literature search and synthesis of the findings and published tools to provide an overview of the current state of improving the diagnosis of UTIs in nursing homes. The following topics are covered: prevalence of asymptomatic bacteriuria, diagnostic challenges, clinical criteria, urinary testing, and algorithms to be implemented in nursing home facilities. Diagnosing UTIs in residents is challenging due to the high prevalence of asymptomatic bacteriuria and nonspecific urinary tract signs and symptoms among those with suspected UTIs. The fear of missing a UTI and the perceived antibiotic demands from residents and relatives might lead to overdiagnosis of this common condition. Despite their widespread use, urine dipsticks should not be recommended for geriatric patients. Patients who do not meet the minimum diagnostic criteria for UTIs should be evaluated for alternative conditions. Adherence to a simple algorithm can prevent unnecessary antibiotic courses without compromising resident safety.
Overdiagnosis of urinary tract infections (UTIs) is one of the most common reasons for the unnecessary use of antibiotics in nursing homes, increasing the risk of missing serious conditions. Various decision tools and algorithms aim to aid in UTI diagnosis and the initiation of antibiotic therapy for residents. However, due to the lack of a clear reference standard, these tools vary widely and can be complex, with some requiring urine testing. As part of the European-funded IMAGINE project, aimed at improving antibiotic use for UTIs in nursing home residents, we have reviewed the recommendations.BACKGROUNDOverdiagnosis of urinary tract infections (UTIs) is one of the most common reasons for the unnecessary use of antibiotics in nursing homes, increasing the risk of missing serious conditions. Various decision tools and algorithms aim to aid in UTI diagnosis and the initiation of antibiotic therapy for residents. However, due to the lack of a clear reference standard, these tools vary widely and can be complex, with some requiring urine testing. As part of the European-funded IMAGINE project, aimed at improving antibiotic use for UTIs in nursing home residents, we have reviewed the recommendations.This review provides a comprehensive summary of the more relevant tools and algorithms aimed at identifying true UTIs among residents living in nursing homes and discusses the challenges in using these algorithms based on updated research.OBJECTIVESThis review provides a comprehensive summary of the more relevant tools and algorithms aimed at identifying true UTIs among residents living in nursing homes and discusses the challenges in using these algorithms based on updated research.The discussion is based on a relevant medical literature search and synthesis of the findings and published tools to provide an overview of the current state of improving the diagnosis of UTIs in nursing homes.SOURCESThe discussion is based on a relevant medical literature search and synthesis of the findings and published tools to provide an overview of the current state of improving the diagnosis of UTIs in nursing homes.The following topics are covered: prevalence of asymptomatic bacteriuria, diagnostic challenges, clinical criteria, urinary testing, and algorithms to be implemented in nursing home facilities.CONTENTThe following topics are covered: prevalence of asymptomatic bacteriuria, diagnostic challenges, clinical criteria, urinary testing, and algorithms to be implemented in nursing home facilities.Diagnosing UTIs in residents is challenging due to the high prevalence of asymptomatic bacteriuria and nonspecific urinary tract signs and symptoms among those with suspected UTIs. The fear of missing a UTI and the perceived antibiotic demands from residents and relatives might lead to overdiagnosis of this common condition. Despite their widespread use, urine dipsticks should not be recommended for geriatric patients. Patients who do not meet the minimum diagnostic criteria for UTIs should be evaluated for alternative conditions. Adherence to a simple algorithm can prevent unnecessary antibiotic courses without compromising resident safety.IMPLICATIONSDiagnosing UTIs in residents is challenging due to the high prevalence of asymptomatic bacteriuria and nonspecific urinary tract signs and symptoms among those with suspected UTIs. The fear of missing a UTI and the perceived antibiotic demands from residents and relatives might lead to overdiagnosis of this common condition. Despite their widespread use, urine dipsticks should not be recommended for geriatric patients. Patients who do not meet the minimum diagnostic criteria for UTIs should be evaluated for alternative conditions. Adherence to a simple algorithm can prevent unnecessary antibiotic courses without compromising resident safety.
Author Glasa, Jozef
Antsupova, Valeria S.
García-Sangenís, Ana
Modena, Daniela
Petelos, Elena
López-Valcárcel, Beatriz González
Ruppe, Georg
Karkana, Maria-Nefeli
Morros Pedrós, Rosa
Radzeviciene, Ruta
Chalkidou, Athina
Sodja, Nina
Kowalczyk, Anna
Døssing-Poulsen, Nina Camilla
Monfà, Ramon
Munck, Anders
Ricart, Marta
Elistratova, Marina
Tsoulchai, Greta
Godycki-Cwirko, Maciej
Briones, Sergi
Lionis, Christos
Petek, Davorina
Benkő, Ria
Døssing Berntsen, Susanne
Glasová, Helena
Llor, Carl
Theut, Anna Marie
Angelaki, Agapi
Balint, András
Vallejo-Torres, Laura
Kanstrup Olsen, Jonas
Tang Hall, Asbjørn
Squaglia, Ana
Moragas, Ana
Bjerrum, Lars
Lykkegaard, Jesper
Jensen, Jette Nygaard
Jaruseviciene, Lina
Marloth, Tina
Anastasaki, Marilena
Álvarez, Laura
Bjerrum, Anders
Hansen, Malene Plejdrup
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ContentType Journal Article
Contributor Glasa, Jozef
García-Sangenís, Ana
Modena, Daniela
Petelos, Elena
López-Valcárcel, Beatriz González
Karkana, Maria-Nefeli
Morros Pedrós, Rosa
Radzeviciene, Ruta
Chalkidou, Athina
Døssing-Poulsen, Nina Camilla
Monfà, Ramon
Munck, Anders
Ricart, Marta
Elistratova, Marina
Tsoulchai, Greta
Godycki-Cwirko, Maciej
Briones, Sergi
Lionis, Christos
Benkő, Ria
Døssing Berntsen, Susanne
Glasová, Helena
Angelaki, Agapi
Balint, András
Vallejo-Torres, Laura
Kanstrup Olsen, Jonas
Tang Hall, Asbjørn
Squaglia, Ana
Jaruseviciene, Lina
Marloth, Tina
Anastasaki, Marilena
Álvarez, Laura
Bjerrum, Anders
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Issue 12
Keywords Nursing homes
Signs and symptoms
Urinary tract infection
Frail elderly
Bacteriuria
Urinalysis
Antibiotic prescribing
Language English
License This is an open access article under the CC BY-NC-ND license.
Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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  article-title: Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomized controlled trial
  publication-title: BMJ
  doi: 10.1136/bmj.38602.586343.55
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Snippet Overdiagnosis of urinary tract infections (UTIs) is one of the most common reasons for the unnecessary use of antibiotics in nursing homes, increasing the risk...
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SubjectTerms Algorithms
Anti-Bacterial Agents - therapeutic use
Antibiotic prescribing
Bacteriuria
Bacteriuria - diagnosis
Catheters, Indwelling - adverse effects
Frail elderly
Humans
Nursing Homes
Prevalence
Signs and symptoms
Urinalysis
Urinary tract infection
Urinary Tract Infections - diagnosis
Title Diagnosing probable urinary tract infections in nursing home residents without indwelling catheters: a narrative review
URI https://dx.doi.org/10.1016/j.cmi.2024.08.020
https://www.ncbi.nlm.nih.gov/pubmed/39209268
https://www.proquest.com/docview/3099801999
http://hdl.handle.net/10553/134378
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Volume 30
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