Article

Prevention of urinary tract infections in nursing homes: lack of evidence-based prescription?

Regional medicines information and pharmacovigilance centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway.
BMC Geriatrics (Impact Factor: 2). 11/2011; 11:69. DOI: 10.1186/1471-2318-11-69
Source: PubMed

ABSTRACT Urinary tract infections (UTIs, including upper and lower symptomatic) are the most common infections in nursing homes and prevention may reduce patient suffering, antibiotic use and resistance. The spectre of agents used in preventing UTIs in nursing homes is scarcely documented and the aim of this study was to explore which agents are prescribed for this purpose.
We conducted a one-day, point-prevalence study in 44 Norwegian nursing homes during April-May 2006. Nursing home residents prescribed any agent for UTI prophylaxis were included. Information recorded was type of agent and dose, patient age and gender, together with nursing home characteristics. Appropriateness of prophylactic prescribing was evaluated with references to evidence in the literature and current national guidelines.
The study included 1473 residents. 18% (n = 269) of the residents had at least one agent recorded as prophylaxis of UTI, varying between 0-50% among the nursing homes. Methenamine was used by 48% of residents prescribed prophylaxis, vitamin C by 32%, and cranberry products by 10%. Estrogens were used by 30% but only one third was for vaginal administration. Trimethoprim and nitrofurantoin were used as prophylaxis by 5% and 4%, respectively.
The agents frequently prescribed to prevent UTIs in Norwegian nursing homes lack documented efficacy including methenamine and vitamin C. Recommended agents like trimethoprim, nitrofurantoin and vaginal estrogens are infrequently used. We conclude that prescribing of prophylactic agents for UTIs in nursing homes is not evidence-based.

Full-text

Available from: Jan Schjøtt, May 30, 2015
2 Followers
 · 
518 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Urinary tract infection is a common problem of elderly populations. Clinical trials addressing urinary infection in the elderly frequently use nonstandardized diagnostic criteria, which compromises the validity of conclusions. Studies of prevention of infection in postmenopausal women in the community consistently report outcomes similar to observations in premenopausal women. Antimicrobial prophylaxis or self-treatment is effective, and cranberry products or probiotics are not beneficial. Critical evaluation of nursing home populations reports no association between nonspecific, nonlocalizing symptoms of any duration and bacteriuria. Optimal antimicrobial use for urinary infection, particularly for residents of long term care facilities, remains challenging. A high proportion of residents in some facilities receive prophylactic therapy to prevent urinary tract infections without evidence to support this practice. Evaluations of multifaceted antimicrobial stewardship programs to improve antimicrobial use in nursing homes report modest benefits.
    09/2013; 2(3). DOI:10.1007/s13670-013-0046-5
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: To determine whether cranberry capsules prevent urinary tract infection (UTI) in long-term care facility (LTCF) residents. DESIGN: Double-blind randomized placebo-controlled mul-ticenter trial. SETTING: Long-term care facilities (LTCFs). PARTICIPANTS: LTCF residents (N = 928; 703 women, median age 84). MEASUREMENTS: Cranberry and placebo capsules were taken twice daily for 12 months. Participants were strati-fied according to UTI risk (risk factors included long-term catheterization, diabetes mellitus, ≥1 UTI in preceding year). Main outcomes were incidence of UTI according to a clinical definition and a strict definition. RESULTS: In participants with high UTI risk at baseline (n = 516), the incidence of clinically defined UTI was lower with cranberry capsules than with placebo (62.8 vs 84.8 per 100 person-years at risk, P = .04); the treatment effect was 0.74 (95% confidence interval (CI) = 0.57– 0.97). For the strict definition, the treatment effect was 1.02 (95% CI = 0.68–1.55). No difference in UTI inci-dence between cranberry and placebo was found in partici-pants with low UTI risk (n = 412). CONCLUSION: In LTCF residents with high UTI risk at baseline, taking cranberry capsules twice daily reduces the incidence of clinically defined UTI, although it does not reduce the incidence of strictly defined UTI. No difference in incidence of UTI was found in residents with low UTI risk. J Am Geriatr Soc 62:103–110, 2014. U rinary tract infection (UTI) is a common bacterial infection in residents of long-term care facilities (LTCF), 1,2 accounting for nearly 25% of all infections. 3,4 UTI not only causes several days of illness, but may have more-severe consequences such as delirium, dehydration, urosepsis, hospitalization, or even death. 5,6 Interventions to prevent UTI could reduce these severe consequences, 7 but there are no evidence-based interven-tions that decrease UTI in institutionalized populations. 1 The use of prophylactic antibiotics is currently controversial because of side-effects and antibiotic resistance. 8,9 Prophy-laxis with cranberry is a potential prevention strategy. 10,11 Cranberries contain proanthocyanidins (PACs), which are stable phenolic compounds with anti-adhesion activity against Escherichia coli. 12–14 In vitro, antibacterial activity of concentrated cranberry juice against other pathogens such Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Proteus mirabilis has also been demon-strated. 15,16 There is aggregated evidence that cranberry juice may lead to a decrease in the incidence of symptomatic UTIs over a 12-month period, particularly in women with recurrent UTIs. 17,18 Another recent systematic review indi-cates that cranberry-containing products are associated with a protective effect against UTI in different sub-groups, albeit with heterogeneity across the included tri-als. 19 A recent study in children without urological abnormalities showed a 65% reduction of UTI with the use of cranberry. 20
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To determine whether cranberry capsules prevent urinary tract infection (UTI) in long-term care facility (LTCF) residents. Design: Double-blind randomized placebo-controlled multicenter trial. Setting: Long-term care facilities (LTCFs). Participants: LTCF residents (N = 928; 703 women, median age 84). Measurements: Cranberry and placebo capsules were taken twice daily for 12 months. Participants were stratified according to UTI risk (risk factors included long-term catheterization, diabetes mellitus, ≥1 UTI in preceding year). Main outcomes were incidence of UTI according to a clinical definition and a strict definition. Results: In participants with high UTI risk at baseline (n = 516), the incidence of clinically defined UTI was lower with cranberry capsules than with placebo (62.8 vs 84.8 per 100 person-years at risk, P = .04); the treatment effect was 0.74 (95% confidence interval (CI) = 0.57–0.97). For the strict definition, the treatment effect was 1.02 (95% CI = 0.68–1.55). No difference in UTI incidence between cranberry and placebo was found in participants with low UTI risk (n = 412). Conclusion: In LTCF residents with high UTI risk at baseline, taking cranberry capsules twice daily reduces the incidence of clinically defined UTI, although it does not reduce the incidence of strictly defined UTI. No difference in incidence of UTI was found in residents with low UTI risk.
    Journal of the American Geriatrics Society 01/2014; 62(1):103-110. DOI:10.1111/jgs.12593 · 4.22 Impact Factor