Asymptomatic bacteriuria in older adults: the most fragile women are prone to long-term colonization
Asymptomatic bacteriuria in older adults: the most fragile women are prone to long-term colonization
复制标题
DOI：
10.1186/s12877-019-1181-4
复制
发表时间：
2019-06-21
期刊：
影响因子：
4.1
通讯作者：
Moons, Pieter
中科院分区：
文献类型：
--
作者：
Biggel, Michael;Heytens, Stefan;Moons, Pieter
研究背景：对住院老年人尿路感染（UTIs）的诊断通常基于模糊的症状和阳性培养。无症状菌尿症（ABU）的高患病率，在这一人群中不能轻易地与急性感染区分开来，经常被忽视，导致抗生素的大量过度处方。本研究的目的是确定亚群倾向于短暂或长期ABU.MethodsResidents在长期护理设施进行筛选ABU。在两个采样周期，间隔10周，每个组成的初始和一个确认的后续samples.ResultsABU发生在大约40%的参与者，主要是由大肠杆菌的中间流尿样收集。30%的受试者出现长期ABU（> 3个月）。患有尿失禁和痴呆的最虚弱的女性的ABU率急剧增加，特别是长期ABU。ABU是最好的预测规模描述的功能独立的老年adults. ConclusionsInstitutional女性尿失禁ABU患病率约为80%，往往是持久的载体。在临床决策中应考虑这种患病率，因为它们降低了阳性尿培养作为诊断UTI标准的意义。迫切需要诊断策略，以避免抗生素过度使用，并确定患者的风险，发展上尿路感染。
BackgroundThe diagnosis of urinary tract infections (UTIs) in institutionalized older adults is often based on vague symptoms and a positive culture. The high prevalence of asymptomatic bacteriuria (ABU), which cannot be easily discriminated from an acute infection in this population, is frequently neglected, leading to a vast over-prescription of antibiotics. This study aimed to identify subpopulations predisposed to transient or long-term ABU.MethodsResidents in a long-term care facility were screened for ABU. Mid-stream urine samples were collected during two sampling rounds, separated by 10 weeks, each consisting of an initial and a confirmative follow-up sample.ResultsABU occurred in approximately 40% of the participants and was mostly caused by Escherichia coli. Long-term ABU (>3months) was found in 30% of the subjects. The frailest women with urinary incontinence and dementia had drastically increased rates of ABU and especially long-term ABU. ABU was best predicted by a scale describing the functional independence of older adults.ConclusionsInstitutionalized women with incontinence have ABU prevalence rates of about 80% and are often persistent carriers. Such prevalence rates should be considered in clinical decision making as they devalue the meaning of a positive urine culture as a criterion to diagnose UTIs. Diagnostic strategies are urgently needed to avoid antibiotic overuse and to identify patients at risk to develop upper UTI.