Diagnosis, Treatment, and Prevention of Urinary Tract Infections in Post-Acute and Long-Term Care Settings: A Consensus Statement From AMDA's Infection Advisory Subcommittee

Muhammad S Ashraf; Swati Gaur; Oluma Y Bushen; Teena Chopra; Philip Chung; Kalin Clifford; Elizabeth Hames; Cees M P M Hertogh; Amar Krishna; Dheeraj Mahajan; David R Mehr; Vycki Nalls; Theresa Ann Rowe; Steven J Schweon; Philip D Sloane; Kavita K Trivedi; Laura W van Buul; Robin L P Jump; Infection Advisory SubCommittee for AMDA—The Society of Post-Acute and Long-Term Care Medicine

doi:10.1016/j.jamda.2019.11.004

Diagnosis, Treatment, and Prevention of Urinary Tract Infections in Post-Acute and Long-Term Care Settings: A Consensus Statement From AMDA's Infection Advisory Subcommittee

J Am Med Dir Assoc. 2020 Jan;21(1):12-24.e2. doi: 10.1016/j.jamda.2019.11.004.

Authors

Muhammad S Ashraf¹, Swati Gaur², Oluma Y Bushen³, Teena Chopra⁴, Philip Chung⁵, Kalin Clifford⁶, Elizabeth Hames⁷, Cees M P M Hertogh⁸, Amar Krishna⁴, Dheeraj Mahajan⁹, David R Mehr¹⁰, Vycki Nalls¹¹, Theresa Ann Rowe¹², Steven J Schweon¹³, Philip D Sloane¹⁴, Kavita K Trivedi¹⁵, Laura W van Buul⁸, Robin L P Jump¹⁶; Infection Advisory SubCommittee for AMDA—The Society of Post-Acute and Long-Term Care Medicine

Affiliations

¹ Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE. Electronic address: -salman.ashraf@unmc.edu.
² New Horizons Nursing Facilities, Gainesville, GA.
³ Royal C. Johnson VA Medical Center, Sioux Falls, SD; Department of Internal Medicine, USD Sanford School of Medicine, Sioux Falls, SD.
⁴ Division of Infectious Diseases, Wayne State University, Detroit, MI.
⁵ Department of Pharmacy, Nebraska Antimicrobial Stewardship Assessment and Promotion Program, Nebraska Medicine, Omaha, NE.
⁶ Division of Geriatrics and Pediatrics, Department of Pharmacy Practice, Texas Tech University Health Sciences Center-School of Pharmacy, Dallas, TX.
⁷ Department of Geriatrics, NSU-COM, Broward Health, Fort Lauderdale, FL.
⁸ Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam University Medical Center, Amsterdam, the Netherlands.
⁹ Chicago Internal Medicine Practice and Research (CIMPAR, SC), Oak Park, IL.
¹⁰ MU Center for Patient-Centered Outcomes Research, Columbia, MO.
¹¹ Capital Caring Hospice, Merrifield, VA.
¹² General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
¹³ Saylorsburg, PA.
¹⁴ Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC.
¹⁵ Trivedi Consults LLC, Berkeley, CA.
¹⁶ Geriatric Research Education and Clinical Center (GRECC), and the Specialty Care Center of Innovation, at the VA Northeast Ohio Healthcare System, Cleveland, OH; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH.

PMID: 31888862
DOI: 10.1016/j.jamda.2019.11.004

Abstract

The diagnosis and management of urinary tract infections (UTIs) among residents of post-acute and long-term care (PALTC) settings remains challenging. Nonspecific symptoms, complex medical conditions, insufficient awareness of diagnostic criteria, and unnecessary urine studies all contribute to the inappropriate diagnosis and treatment of UTIs in PALTC residents. In 2017, the Infection Advisory Subcommittee at AMDA-The Society for Post-Acute and Long-Term Care Medicine convened a workgroup comprised of experts in geriatrics and infectious diseases to review recent literature regarding UTIs in the PALTC population. The workgroup used evidence as well as their collective clinical expertise to develop this consensus statement with the goal of providing comprehensive guidance on the diagnosis, treatment, and prevention of UTIs in PALTC residents. The recommendations acknowledge limitations inherent to providing medical care for frail older adults, practicing within a resource limited setting, and prevention strategies tailored to PALTC populations. In addition, the consensus statement encourages integrating antibiotic stewardship principles into the policies and procedures used by PALTC nursing staff and by prescribing clinicians as they care for residents with a suspected UTI.

Keywords: Urinary tract infection; antimicrobial stewardship; infection prevention and control; nursing homes.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Advisory Committees
Anti-Bacterial Agents / therapeutic use
Antimicrobial Stewardship
Consensus
Humans
Residential Facilities*
Urinary Tract Infections / diagnosis*
Urinary Tract Infections / drug therapy*
Urinary Tract Infections / prevention & control*

Substances

Anti-Bacterial Agents