Investigation of suspected urinary tract infection in older people

Ninan, Sean; Walton, Carly; Barlow, Gavin

doi:10.1136/bmj.g4070

Cited by 46 publications

(24 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This widespread use encourages the development of antibiotic resistance [7]. One key cause is asymptomatic bacteriuria (ASB)– a common condition in older persons that is frequently mistaken for infection [8], and which contributes to the finding that up to 70% of prescriptions in NHs do not meet clinical guidelines for appropriate prescribing [9, 10]. …”

Section: Introductionmentioning

confidence: 99%

Nursing home nurses’ and community-dwelling older adults’ reported knowledge, attitudes, and behavior toward antibiotic use

et al. 2017

View full text Add to dashboard Cite

BackgroundAntibiotic overuse causes antibiotic resistance, one of the most important threats to human health. Older adults, particularly those in nursing homes, often receive antibiotics when they are not indicated.MethodsTo understand knowledge, attitudes, and behaviors of nursing home (NH) nurses and community-dwelling older adults towards antibiotic use, especially in clinical situations consistent with antibiotic overuse, we conducted a mixed-method survey in two NHs and one Family Medicine clinic in North Carolina, among English-speaking nurses and community-dwelling, cognitively intact adults aged 65 years or older. Based on the Knowledge-Attitude-Practice model, the survey assessed knowledge, attitudes, and behavior towards antibiotic use, including three vignettes designed to elicit possible antibiotic overuse: asymptomatic bacteriuria (ASB), a viral upper respiratory illness (URI), and a wound from a fall.ResultsOf 31 NH nurses and 66 community-dwelling older adults, 70% reported knowledge of the dangers of taking antibiotics. Nurses more often reported evidence-based attitudes towards antibiotics than older adults, except 39% agreed with the statement “by the time I am sick enough to go to the doctor with a cold, I expect an antibiotic”, while only 28% of older adults agreed with it. A majority of nurses did not see the need for antibiotics in any of the three vignettes: 77% for the ASB vignette, 87% for the URI vignette, and 97% for the wound vignette. Among older adults, 50% did not perceive a need for antibiotics in the ASB vignette, 58% in the URI vignette, and 74% in the wound vignette.ConclusionsWhile a substantial minority had no knowledge of the dangers of antibiotic use, non-evidence-based attitudes towards antibiotics, and behaviors indicating inappropriate management of suspected infections, most NH nurses and community-dwelling older adults know the harms of antibiotic use and demonstrate evidence-based attitudes and behaviors. However, more work is needed to improve the knowledge, attitudes and behaviors that may contribute to antibiotic overuse.

show abstract

Section: Introductionmentioning

confidence: 99%

Nursing home nurses’ and community-dwelling older adults’ reported knowledge, attitudes, and behavior toward antibiotic use

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Among nursing home (NH) residents, clinical decision‐making for suspected UTIs poses additional challenges for a variety of reasons. For one, ASB rates are particularly high in NHs; as many as half of all positive urine cultures should be considered false positives for the presence of a UTI . Additionally, due to high rates of dementia among NH residents, nurses must often infer the presence of symptoms based on nonverbal responses .…”

mentioning

confidence: 99%

“…For one, ASB rates are particularly high in NHs; as many as half of all positive urine cultures should be considered false positives for the presence of a UTI. 9 Additionally, due to high rates of dementia among NH residents, nurses must often infer the presence of symptoms based on nonverbal responses. 10 Further, NH providers, such as physicians, physicians' assistants, and nurse practitioners, often make decisions with extremely limited information, not knowing an individual resident's medical history 11,12 or not examining a resident at the time of illness presentation.…”

mentioning

confidence: 99%

The Antibiotic Prescribing Pathway for Presumed Urinary Tract Infections in Nursing Home Residents

Kistler

Zimmerman

Scales

et al. 2017

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…Table 1 provides the definitions of terms relating to urinary tract infection. Table 1 Definitions of terms relating to urinary tract infection (adapted from: Ninan., Walton and Barlow, 2014).…”

Section: Definition Of Terms Related To Utimentioning

confidence: 99%

“…Leucocyte esterase is produced by neutraphils and may signal pyuria associated with UTI (Mundt andShanahan, 2011 andLittle et al, 2009). Although urinalysis provides an effective screening tool it should not be used in isolation to guide treatment, due to false positives and false negatives that can occur if the sample is contaminated or left to stand for too long (Ninan., Walton andBarlow, 2014 andSimmerville., Maxted andPahira, 2005). If infection is suspected from the patient's presentation than further testing such as Microsopy, Culture and Sensitivites (MC&S) may be required.…”

Section: Urinalysis and Urine Culturementioning

confidence: 99%