According to the results of a recent study published in the Journal of the American Geriatrics Society, antibiotics were commonly prescribed for Australian nursing home residents with suspected urinary tract infections (UTI) on the basis of new or worsening confusion, among other factors.
To determine the prevalence of documented UTI in nursing home residents, the charts of 450 nursing home residents from tropical Australia were reviewed and cases of documented UTI were recorded. The presence of new or worsening specific or nonspecific symptoms related to the urinary tract, antibiotic use, common medical conditions, and medications were also documented. The correlation between confusion, restlessness, fatigue, and antibiotics prescribed for UTI was evaluated in univariate and multivariate analyses.
A total of 33% of current infections and 40% of all infections in the previous 30 days were suspected or documented UTIs. Of the 13 current cases of UTI that were considered documented, 2 met the revised McGeer criteria, and urine cultures were made in 7 cases.
Of the 40 residents who were receiving antibiotics at the time of review, 16 residents (40%) were receiving antibiotics for a current UTI or prophylactically for UTI.
The most common new or worsening nonspecific UTI symptoms included “not himself or herself” (8.9%), confusion (8.1%), restlessness (5.3%), and fatigue (5.0%). Common specific symptoms included urinary incontinence (3.5%) and urinary frequency (3.3%). New or worsening confusion was strongly associated with urinary frequency (odds ratio [OR] 33; P <.001), current UTI antibiotic prescription (OR 15; P <.001), and having a full blood count measured (OR 8.6; P <.001).
UTI antibiotic use was associated with the presence of a urinary catheter (OR 13; P =.003), urinary frequency (OR 10; P =.003), fever (OR 10; P =.028), new-onset hypotension (OR 10; P =.024), and confusion (OR 8.9; P <.001).
The study authors concluded that, “[nursing home] facilities in the wet tropics in developed countries have the same challenges of overprescription of antibiotics for suspected UTI as observed worldwide, with 1 in every 5 [nursing home] residents receiving antibiotics over a 30-day period, of which almost half were prescribed for suspected UTI.” They noted that future controlled trials “randomizing residents with new-onset confusion and bacteriuria to antibiotic treatment or placebo” may be useful “because of the presence of nonspecific symptoms and asymptomatic bacteriuria.”
Mayne S, Sundvall PD, Gunnarsson R. Confusion strongly associated with antibiotic prescribing due to suspected urinary tract infections in nursing homes [published online January 10, 2018]. J Am Geriatr Soc. doi: 10.1111/jgs.15179