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Challenges in Assessing Nursing Home Residents with Advanced Dementia for Suspected Urinary Tract Infections
Author(s) -
Agata Erika D',
Loeb Mark B.,
Mitchell Susan L.
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12070
Subject(s) - medicine , urinalysis , dysuria , dementia , antimicrobial , urinary system , urine , pediatrics , disease , chemistry , organic chemistry
Objectives To describe the presentation of suspected urinary tract infections ( UTI s) in nursing home ( NH ) residents with advanced dementia and how they align with minimum criteria to justify antimicrobial initiation. Design Twelve‐month prospective study. Setting Twenty‐five NH s. Participants Two hundred sixty‐six NH residents with advanced dementia. Measurements Charts were abstracted monthly for documentation of suspected UTI episodes to determine whether episodes met minimum criteria to initiate antimicrobial therapy according to consensus guidelines. Results Seventy‐two residents experienced 131 suspected UTI episodes. Presenting symptoms and signs for these episodes are mental status change (44.3%), fever (20.6%), hematuria (6.9%), dysuria (3.8%), costovertebral tenderness (2.3%), urinary frequency (1.5%), rigor (1.5%), urgency (0%), and suprapubic pain (0%). Only 21 (16.0%) episodes met minimal criteria to initiate antimicrobial therapy based on signs and symptoms. Of the 110 episodes that lacked minimum criteria to justify antimicrobial initiation, 82 (74.5%) were treated with antimicrobial therapy. Urinalyses and urine culture results were available for 101 episodes, of which 80 (79.2%) had positive results on both tests. The proportion of episodes with a positive urinalysis and culture was similar for those that met (83.3%) and did not meet (78.3%) minimum criteria ( P  = .06). Conclusion The symptoms and signs necessary to meet minimum criteria to support antimicrobial initiation for UTI s are frequently absent in NH residents with advanced dementia. Antimicrobial therapy is prescribed for the majority of suspected UTI s that do not meet these minimum criteria. Urine specimens are frequently positive regardless of symptoms. These observations underscore the need to reconsider the diagnosis and the initiation of treatment for suspected UTI s in advanced dementia.

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