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- Title
Asymptomatic bacteriuria in older adults: the most fragile women are prone to long-term colonization.
- Authors
Biggel, Michael; Heytens, Stefan; Latour, Katrien; Bruyndonckx, Robin; Goossens, Herman; Moons, Pieter
- Abstract
<bold>Background: </bold>The diagnosis of urinary tract infections (UTIs) in institutionalized older adults is often based on vague symptoms and a positive culture. The high prevalence of asymptomatic bacteriuria (ABU), which cannot be easily discriminated from an acute infection in this population, is frequently neglected, leading to a vast over-prescription of antibiotics. This study aimed to identify subpopulations predisposed to transient or long-term ABU.<bold>Methods: </bold>Residents in a long-term care facility were screened for ABU. Mid-stream urine samples were collected during two sampling rounds, separated by 10 weeks, each consisting of an initial and a confirmative follow-up sample.<bold>Results: </bold>ABU occurred in approximately 40% of the participants and was mostly caused by Escherichia coli. Long-term ABU (> 3 months) was found in 30% of the subjects. The frailest women with urinary incontinence and dementia had drastically increased rates of ABU and especially long-term ABU. ABU was best predicted by a scale describing the functional independence of older adults.<bold>Conclusions: </bold>Institutionalized women with incontinence have ABU prevalence rates of about 80% and are often persistent carriers. Such prevalence rates should be considered in clinical decision making as they devalue the meaning of a positive urine culture as a criterion to diagnose UTIs. Diagnostic strategies are urgently needed to avoid antibiotic overuse and to identify patients at risk to develop upper UTI.
- Subjects
BACTERIURIA; OLDER people; FRAIL elderly; BACTERIAL colonies; URINARY tract infections; URINARY incontinence in women; URINALYSIS; LONG-term care facilities
- Publication
BMC Geriatrics, 2019, Vol 19, Issue 1, p1
- ISSN
1471-2318
- Publication type
journal article
- DOI
10.1186/s12877-019-1181-4