Risk factors and consequences of bacteriuria in non-catheterized nursing home residents

Background. There has been disagreement over the significance of bacteriuria in nursing home residents. Methods. During an 18-month period, the risks and consequences of bacteriuria (BU) in 195 residents of a skilled nursing facility without indwelling catheters were examined. Clinical and epidemiologic data and urine for culture were collected every 2 weeks to identify risk factors, symptoms, and occurrences of BU. A mean of 23 cultures per resident was collected. Results. Forty-three percent of the study population (35% of men; 47% of women) had 'persistent BU' defined as >10⁵ cfu/ml of urine on >25% of an individual's collected cultures. Women with persistent BU more frequently were incontinent of bowel and bladder (OR 5.3, 6.3, respectively), more likely to be functionally disabled (OR 3.2), to carry a diagnosis of dementia (OR 2.4), and less likely to have suffered a stroke (OR 0.40). Cancer (OR 6.5) was the only risk factor for persistent BU in men. The number of antibiotic courses prescribed, frequency of hospitalizations, and mortality rates were not significantly different between the two BU groups in either men or women. Conclusions. Persistent BU is common in nursing home residents. The association of bowel and bladder incontinence and functional disability with persistent bacteriuria suggests that treatment or prevention of these risk factors may prevent or decrease the incidence of bacteriuria. There was no evidence of significant adverse outcomes resulting directly from the bacteriuric state. Higher mortality in the bacteriuric group was the result of underlying functional debility and severity of illness rather than the presence or persistence of BU.