Urinary tract infections in non-catheterized nursing home residents

Sixty-five elderly non-catheterized residents of a 275 bed skilled nursing home had 119 separate urinary tract infections as determined by the presence of clinical signs and symptoms as well as a urine culture demonstrating > 10⁵ CFU of a known pathogen between January 1 and June 30, 1989 (mean 1.8 per person). Pyuria was noted in all but 7 infections and all responded clinically to treatment. Presenting signs or symptoms included fever (59.1%), change in mental status (12.4%), genitourinary symptoms (11.7%), lethargy (7.6%), among others. Despite the nursing home's close proximity to an acute hospital where a relatively high incidence of virulent and multiply resistant organisms would be expected, Escherichia coli was the most common infecting organism. It was of note, however, that 30% of the Escherichia coli were resistant to at least one antibiotic. Although women were infected most commonly, no relationship was found to coexisting illness, level of mobility, 6 month mortality, or frequency of hospitalization. Since clinical improvement was noted in all cases, there should be a high index of suspicion for UTI in this population. Due to the large number of atypical and/or nonspecific presentations of UTIs in this population, caution is advised to not too quickly label a urinary tract infection as being an "asymptomatic" bacteriuria.