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

Autor:	Llor C; Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark; Primary Care Research Institute Jordi Gol, Institut d'Investigació en Atenció Primària (IDIAP), Barcelona, Spain; CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: cllor@health.sdu.dk., Moragas A; Primary Care Research Institute Jordi Gol, Institut d'Investigació en Atenció Primària (IDIAP), Barcelona, Spain; CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Department of General Pathology. University Rovira i Virgili, Tarragona, Spain., Ruppe G; Austrian Interdisciplinary Platform on Ageing/Österreichische Plattform für Interdisziplinäre Alternsfragen (OEPIA), Vienna, Austria., Lykkegaard J; Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark., Hansen MP; Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark; Center for General Practice, Aalborg University, Aalborg, Denmark., Antsupova VS; Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark., Jensen JN; Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark., Theut AM; Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark., Petek D; Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia., Sodja N; Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia., Kowalczyk A; Centre for Family and Community Medicine, the Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland., Bjerrum L; Department of Public Health, Section and Research Unit of General Practice, University of Copenhagen, Copenhagen, Denmark.
Jazyk:	angličtina
Zdroj:	Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [Clin Microbiol Infect] 2024 Aug 30. Date of Electronic Publication: 2024 Aug 30.
DOI:	10.1016/j.cmi.2024.08.020
Abstrakt:	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. (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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