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

IF 10.9 1区 医学 Q1 INFECTIOUS DISEASES Clinical Microbiology and Infection Pub Date : 2024-08-30 DOI:10.1016/j.cmi.2024.08.020
Carl Llor, Ana Moragas, Georg Ruppe, Jesper Lykkegaard, Malene Plejdrup Hansen, Valeria S Antsupova, Jette Nygaard Jensen, Anna Marie Theut, Davorina Petek, Nina Sodja, Anna Kowalczyk, Lars Bjerrum
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Abstract

Background: 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.

Objectives: 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.

Sources: 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.

Content: The following topics are covered: prevalence of asymptomatic bacteriuria, diagnostic challenges, clinical criteria, urinary testing, and algorithms to be implemented in nursing home facilities.

Implications: 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.

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对未留置导尿管的养老院住户进行可能的尿路感染诊断:叙述性综述。
背景:尿路感染(UTI)的过度诊断是养老院不必要使用抗生素的最常见原因之一,增加了漏诊严重疾病的风险。各种决策工具和算法旨在帮助UTI 诊断和对住院患者进行抗生素治疗。然而,由于缺乏明确的金标准,这些工具差异很大,而且可能很复杂,有些还需要进行尿检。作为欧洲资助的 IMAGINE 项目的一部分,旨在改善疗养院居民 UTI 抗生素的使用,我们对相关建议进行了综述:本综述全面总结了旨在识别疗养院居民真正尿毒症的相关工具和算法,并根据最新研究讨论了使用这些算法所面临的挑战:讨论基于相关医学文献检索,并对研究结果和已发表的工具进行综合,以概述改善疗养院 UTIs 诊断的现状:内容:涵盖以下主题:无症状菌尿的流行率、诊断挑战、临床标准、尿液检测以及养老院设施中应实施的算法:由于疑似尿毒症患者中无症状菌尿和非特异性尿路体征和症状的发生率很高,因此对住院患者进行尿毒症诊断具有挑战性。由于害怕漏诊尿路感染以及居民和亲属对抗生素的需求,可能会导致对这种常见疾病的过度诊断。尽管尿液滴定管被广泛使用,但不应推荐老年患者使用。对于不符合尿毒症最低诊断标准的患者,应评估其是否患有其他疾病。坚持使用简单的算法可以避免不必要的抗生素治疗,同时又不会影响住院患者的安全。
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来源期刊
CiteScore
25.30
自引率
2.10%
发文量
441
审稿时长
2-4 weeks
期刊介绍: Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.
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