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BMC Geriatr. 2019 Jun 21;19(1):170. doi: 10.1186/s12877-019-1181-4.

Asymptomatic bacteriuria in older adults: the most fragile women are prone to long-term colonization.

Author information

1
Laboratory of Medical Microbiology, University of Antwerp, Universiteitsplein 1, building S, 2610 Wilrijk, Antwerp, Belgium.
2
Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
3
Operational Directorate Epidemiology & Public Health, Sciensano, Brussels, Belgium.
4
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
5
Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Hasselt, Belgium.
6
Laboratory of Medical Microbiology, University of Antwerp, Universiteitsplein 1, building S, 2610 Wilrijk, Antwerp, Belgium. pieter.moons@uza.be.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

Asymptomatic bacteriuria; Older adults; Urinary tract infection

PMID:
31226945
PMCID:
PMC6588879
DOI:
10.1186/s12877-019-1181-4
[Indexed for MEDLINE]
Free PMC Article

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