Urinary tract infection in long-term care facilities

Introduction

Asymptomatic bacteriuria and pyuria are pervasive in the long-term care population. Optimal management of urinary infection for residents of long-term care facilities requires knowledge of the unique features of the infection in this setting, together with critical evaluation of each episode of potential urinary infection in the individual resident.

Method

A non-structured review of current knowledge and recommendations relevant to urinary infection in long-term care facilities.

Results

Urinary infection is the second most common infection occurring in long-term care facility residents. For residents without chronic indwelling catheters, acute, localising, genitourinary symptoms should be present to support a clinical diagnosis of symptomatic infection. Inappropriate antimicrobial use for urinary tract infection, particularly treatment of asymptomatic bacteriuria and prophylaxis of urinary infection, is a consistent observation in reviews of antimicrobial use in these facilities. Management approaches to improve treatment include observation and reassessment when symptoms are questionable or the diagnosis is unclear, limiting the use of chronic indwelling catheters, and early identification of complications, such as obstruction, of indwelling catheters.

Conclusions

Clinical diagnostic imprecision and a high prevalence of asymptomatic bacteriuria means these infections are overdiagnosed and overtreated, leading to adverse events from excess antimicrobial use. Antimicrobial stewardship programs to improve antimicrobial use for this indication need to be developed in long-term care facilities.