Urinary Antibody Level and Survival in Bacteriuric Institutionalized Older Subjects

Nicolle, Lindsay E.; Duckworth, Heather; Brunka, J.; Urias, B.; Kennedy, J. S.; Murray, David; Harding, G. K. M.

doi:10.1016/s0022-5347(01)61750-6

Cited by 3 publications

(12 citation statements)

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“…In addition, there has been no correlation between renal disease and bacteriuria demonstrated in this client profile 15 . However, there is an association in the high occurrence of urinary tract infection (UTI) or pyuria and a slow decline in functioning 10,15 . This might be associated with the changes to the immune system and the client's inability to resist infection 10 .…”

Section: Urinalysismentioning

confidence: 82%

“…The same study also notes that asymptomatic bacteriuria is not predictive in the assumption that it leads to infective renal disease of even altered serum creatinine or blood pressure 10 . Brockelhurst 13 proposed that chronic bacteriuria in the elderly might be related to residual urine quantities and, therefore, bladder dysfunction should be the main focus initially rather than the infective process.…”

Section: Diagnostic Considerationmentioning

confidence: 95%

“…Not only did the studies emphasize the impact of the ageing process on the function of the urinary tract, there was also a variance in the presentation of symptoms in the older client which differed from those experienced by younger adults (Table 2). 8–10 …”

Section: Diagnostic Considerationmentioning

confidence: 99%

“…One study demonstrated how the disease process impacts on the potential to harbour infection. Clients found to have an asymptomatic bacteriuria might have required no antimicrobial intervention, but the research demonstrated that those clients with elevated urine antibodies in addition to bacteriuria had poorer survival rates 10 . Gross assessment based on observations regarding the potential for immune dysregulation could be associated with ageing or comorbidity, and an elevated urine antibody in this client profile might indicate immune dysregulation.…”

Section: Diagnostic Considerationmentioning

confidence: 99%

“…However, there is an association in the high occurrence of urinary tract infection (UTI) or pyuria and a slow decline in functioning 10,15 . This might be associated with the changes to the immune system and the client's inability to resist infection 10 . The rationale for not treating asymptomatic UTIs with antimicrobial drugs is that in the presence of large amounts bacteria, preventing distress for the client might be protection against more virulent strains of bacteria.…”

Section: Urinalysismentioning

confidence: 99%

See 4 more Smart Citations

Systematic review of nursing management of urinary tract infections in the cognitively impaired elderly client in residential care: Is there a hole in holistic care?

Brown

2002

Int J of Nursing Practice

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A systematic review of the current literature available exposed the deficit in nursing research as a resource for planning strategies and procedures in the care of a urinary tract infection. The cognitively impaired older client living in residential care is at particular risk because of their inability to articulate their problems, the subtle presentation of symptoms and the overuse of antibiotic therapy that has led to an increase in resistant organisms. The fiscal responsibility now required by health authorities highlights the need for a more enlightened approach to this distressing condition from those registered nurses in the front line of care.

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Section: Urinalysismentioning

confidence: 82%

Section: Diagnostic Considerationmentioning

confidence: 95%

Section: Diagnostic Considerationmentioning

confidence: 99%

Section: Diagnostic Considerationmentioning

confidence: 99%

Section: Urinalysismentioning

confidence: 99%

See 3 more Smart Citations

Systematic review of nursing management of urinary tract infections in the cognitively impaired elderly client in residential care: Is there a hole in holistic care?

Brown

2002

Int J of Nursing Practice

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You Are What You Urinate: Fact or Fiction

Yoshikawa

1998

J American Geriatrics Society

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a years ago when I was a medical student, the instruc-sever tor for I tlie renal physiology lecture began his reniarks with the words, "You are what you urinate." It was not until I began the clinical practice and study of internal medicine did I realize the true meaning and relative validity of that prophetic comment. Certainly, a careful exaniination and analysis of urine will often provide a vast amount of information about patients, including normal physiology, changing homeostasis, and underlying diseases or disorders. Moreover, findings in the urine niay have predictive value: early detection of proteinuria in diabetics heralds the onset of diabetic ~iephropathy.'-~ Earlier studies of institutionalized older residents indicated that the presence of bacteriuria (generally asymptomatic) predicted a higher mortality rate cornpared with residents who were aba~teriuric?-~ I-Iowcver, subsequent investigations refuted these findings and suggested no such association between bacteriuria and niortality.8-'1 Furthermore, when antimicrobial therapy was administered to bacteriuric (symptomatic and asymptomatic) institutionalized older adults, mortality was not substantially affect-So what does the clinician conclude from these conflicting findings?To add further to the challenge of better understanding tlie relevance of asymptomatic bacteriuria in this population, Nicolle and colleagues, in this issue of JAGS," have investigated what might be factors that influence mortality in institutionalized residents who are bacteriuric. In an earlier preliminary study, Nicolle and colleagues found that institutionalized bacteriuric older adults with elevated levels of urine antibody to tlie major outer membrane of Escherichia coli had a survival rate of approximately 20% of those subjects with normal urine antibody levels at the end of 3 years.'6 Moreover, bacteriuric older people with normal urine antibody levels had survival rates similar to abacteriuric residents. In the current study," this observation has been pursued further by a prospective, 24-nlonth observational cohort investigation of 98 bacteriuric older residents (age range 61-94 years) from three long-term care facilities. Again, it was found that there was a correlation between high levels of urine antibody (to outer membrane antigens of E. coli) and increased mortality (68% vs 17%) in comparison with study subjects who had bacteriuria and low levels of urine antibodies. This association remained valid regardless of gender, presence or absence of a urinary catheter, presence or absence of urinary symptoms, and study site. Curiously, in comparison with subjects with low levels of urine antibodies, the high-level group did not have greater or more rapid decrements in nutritional anthromorphonietric measures, physical functional capacity, or cognitive parameters. However, not mentioned in this study were the data on serum albumin, cutaneous anergy status, details of physical performance measures, relationship of urine antibody levels and ,d.12-14 elimination or persis...

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Asymptomatic Bacteriuria and Bacterial Interference

Nicolle

2015

Microbiol Spectr

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Asymptomatic bacteriuria is very common. In healthy women, asymptomatic bacteriuria increases with age, from <1% in newborns to 10% to 20% of women age 80 years, but is uncommon in men until after age 50 years. Individuals with underlying genitourinary abnormalities, including indwelling devices, may also have a high frequency of asymptomatic bacteriuria, irrespective of age or gender. The prevalence is very high in residents of long-term-care facilities, from 25% to 50% of women and 15% to 40% of men. Escherichia coli is the most frequent organism isolated, but a wide variety of other organisms may occur. Bacteriuria may be transient or persist for a prolonged period. Pregnant women with asymptomatic bacteriuria identified in early pregnancy and who are untreated have a risk of pyelonephritis later in pregnancy of 20% to 30%. Bacteremia is frequent in bacteriuric subjects following mucosal trauma with bleeding, with 5% to 10% of patients developing severe sepsis or septic shock. These two groups with clear evidence of negative outcomes should be screened for bacteriuria and appropriately treated. Asymptomatic bacteriuria in other populations is benign and screening and treatment are not indicated. Antimicrobial treatment has no benefits but is associated with negative outcomes including reinfection with antimicrobial resistant organisms and a short-term increased frequency of symptomatic infection post-treatment. The observation of increased symptomatic infection post-treatment, however, has led to active investigation of bacterial interference as a strategy to prevent symptomatic episodes in selected high risk patients.

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Urinary Antibody Level and Survival in Bacteriuric Institutionalized Older Subjects

Cited by 3 publications

References 0 publications

Systematic review of nursing management of urinary tract infections in the cognitively impaired elderly client in residential care: Is there a hole in holistic care?

Systematic review of nursing management of urinary tract infections in the cognitively impaired elderly client in residential care: Is there a hole in holistic care?

You Are What You Urinate: Fact or Fiction

Asymptomatic Bacteriuria and Bacterial Interference

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