Many nursing home residents in tropical Australia received antibiotics for urinary tract infections because of symptoms that were not specific to the urinary tract, according to researchers.
One such symptom — confusion in residents — was especially prevalent among patients prescribed antibiotics for UTI, the researchers wrote in the Journal of the American Geriatrics Society. These presumptive diagnoses can lead to overuse of antibiotics in Australia and elsewhere and contribute the threat of antimicrobial resistance, they said.
“Studies have shown that residents with confusion and dementia are more likely to be continuously bacteriuric without an established UTI,” researcher Sean Mayne, MBBS, of the James Cook University Cairns Clinical School in Queensland, Australia, and colleagues wrote. “This is a troubling clinical problem because studies have demonstrated that elderly residents with asymptomatic bacteriuria should not receive antibiotics. It results in overdiagnosis of UTI and a significant overuse of antibiotics.”
The researchers conducted an observational study of residents at five nursing homes in far northern Queensland between Aug. 28, 2015, and June 21, 2016. Nursing staff collected data on 450 residents, including demographics, new or worsening symptoms that are specific and nonspecific to the urinary tract, common medical conditions, medications received and documented UTI.
The staff did not collect information on how UTI was diagnosed. They did, however, use elements of the revised McGreer criteria — a standardized guide for infection surveillance and definitions in long-term care facilities — to estimate how many diagnoses met McGreer criteria, the researchers said.
In all, 13 residents had a documented UTI during data collection. Of those, two residents “clearly met the revised McGreer criteria,” Mayne and colleagues said, and only seven had a urine culture performed. Of the 40 residents with a documented UTI in the previous 30 days, only 25 underwent urine culture. Five UTIs were associated with a urinary tract catheter, they said.
The researchers also found that 33% of infections documented and treated with antibiotics during data collection were diagnosed as UTI. In addition, 40% of infections treated with antibiotics within the previous 30 days of data collection were diagnosed as UTI. One in five residents had received antibiotics within the previous 30 days, and of those, 45% were treated for a suspected UTI.
Confusion was one of the five factors most significantly associated with antibiotic treatment of UTI (OR = 8.9; 95% CI, 3.1-26). The other factors included urinary catheter (OR = 13; 95% CI, 2.4-67), urinary frequency (OR = 10; 95% CI, 2.2-47), fever (OR = 10; 95% CI, 1.3-85) and new-onset hypotension (OR = 10; 95% CI, 1.4-73).
The researchers noted that nursing home facilities in the wet tropics of developed countries face the same challenges of antibiotic overuse for suspected UTIs as the rest of the world. They concluded that because of the presence of nonspecific symptoms and asymptomatic bacteriuria, “the next logical step would be an international collaboration on a controlled trial, randomizing residents with new-onset confusion and bacteriuria to antibiotic treatment or placebo.” – by Joe Green
Disclosures: The authors report no relevant financial disclosures.