Evidence-driven Diagnosis and Treatment of Acute Urinary Tract Infections in Long-term Care

Misdiagnosis of asymptomatic bacteriuria as a urinary tract infection continues to occur, leading to the overuse of antibiotics. Due to the growing elderly population in long-term care facilities (LTCFs), LTCFs can play a critical role in antimicrobial stewardship. Urinary tract infections are a starting point for moving toward antimicrobial stewardship, since urinary tract infections are common in LTCFs. A retrospective chart review of 156 cases with suspected urinary tract infections (UTIs) was completed in a LTCF. The purpose of the scholarly project was to assess diagnostic and treatment practices for UTIs and compare them to a diagnostic and treatment algorithm. The overarching finding of the scholarly project was that this particular LTCF’s management of UTIs did not correspond with the selected algorithm’s recommendations. Because the elderly frequently have complex and confounding health factors related to UTIs, the selected algorithm did not adequately capture the nuances for UTI diagnosis in the elderly population. As currently published, the algorithm is not generalizable to elderly women in LTCFs. The symptoms component of the diagnostic portion of the algorithm may benefit from further revision for use in the elderly population. Small-scale change at LTCFs could include encouragement of watchful waiting and improved use of guidelines for antibiotic treatment.