1 / 13

CLEARING UP THE GERIATRIC UTI

CLEARING UP THE GERIATRIC UTI. Jennifer Yang, MD May 9, 2014 Swedish R3 Talks. 95yo F with dementia, hx urosepsis who has cloudy, foul-smelling urine. She seems “more confused” ROS: ? AFVSS Gen: AAOx1, NAD Abdom : Soft, ?TTP Back: ?CVAT . Should you check a UA/ UCx ?

abby
Télécharger la présentation

CLEARING UP THE GERIATRIC UTI

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CLEARING UP THE GERIATRIC UTI Jennifer Yang, MD May 9, 2014 Swedish R3 Talks

  2. 95yo F with dementia, hxurosepsis who has cloudy, foul-smelling urine. She seems “more confused” ROS: ? AFVSS Gen: AAOx1, NAD Abdom: Soft, ?TTP Back: ?CVAT • Should you check a UA/UCx? • Does she have a UTI?

  3. BACKGROUND • UTI the most common reason for Abx in geriatrics • Elderly at higher risk • Asymptomatic bacteriuria (ASB) highly prevalent, vastly overtreated

  4. IDSA, AMDA, 2013 AGS CHOOSING WISELY Do not screen/treat for ASB in asymptomatic elderly • Screening Treatment • Does not UTI frequency • Bacteriuria + nonspecific symptoms NOT predictive of UTI

  5. 2012 REVISED MCGEER CRITERIA Acute dysuria or acute painful teste/epididymis/prostate OR Fever* orLeukocytosis AND 1 urinary sx: - Acute CVAT -Suprapubicpain - Gross hematuria • - New/incontinence • - New/urgency • - New/frequency OR 2 localizing urinary sx UCx >105CFU/mL(2 bugs) OR 102CFU/mL any bugs (catheterized) *Fever in LTCF: • One temp >100F (PO) • Repeated 99F (PO) or 99.5F (PR) • One temp 2F over baseline

  6. GERIATRIC UTI(Dementia, LTCF) • “Urinary symptoms” can be difficult • Dementia • Chronic GU sx • Altered mental status is most common reason for suspected UTI in LTCF • Fever is variable

  7. SHOULD I TREAT? • What about the UA? • LE + nitrite • NPV 100%! • PPV 37% • Pyuria unreliable • Watch and wait if uncertain • Consider delay empiric Abx for 48h

  8. TREATMENT (uncomplicated UTI)

  9. PREVENTION • Vaginal estrogen cream • Cranberry? • Cochrane 2012: same as placebo • 2014 RCT: 26% reduction in high UTI risk LTCF residents • D-mannose? • Probiotics? • Chronic suppressive Abx – controversial • Condom catheter

  10. TAKE HOME POINTS • Cloudy urine + nonspecific sx do not a UTI make • Revised McGeer Criteria for LTCF • Watch and wait if uncertain • Treat when you have the data

  11. REFERENCES • 2013 AGS Choosing Wisely Campaign • Caljouw, et al. Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infections in Vulnerable Older Persons: A Double-Blind Randomized Placebo-Controlled Trial in Long-Term Care Facilities. JAGS 2014. 62:103-110. • D’Agata, et al. Challenges in assessing nursing home residents with advanced dementia for suspected urinary tract infections. JAGS 2013. 61:62-66. • Gordon, et al. Overtreatment of presumed urinary tract infection in older women presenting to the emergency department. JAGS 2013.61:788-792. • Gupta, et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. CID 2011.52:103-120. • Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD001321. DOI: 10.1002/14651858.CD001321.pub5 • Juthani-Mehta, Manisha. “Update in Infectious Diseases in Older Adults: UTI”. AGS Annual Scientific Meeting 2013 presentation. • Mody & Juthani-Mehta. Urinary tract infections in older women: a clinical review. JAMA 2014.311(8):844-854. • Nace, et al. Clinical uncertainties in the approach to long term care residents with possible urinary tract infection. JAMDA 2014.15(2):133-139. • Nicolle, et al. Infectious Diseases Society of America Guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. CID 2005.40:643-654. • Rowe & Juthani-Mehta. Diagnosis and management of urinary tract infection in older adults. Infectious Disease Clinics of North America 2014. 28(1):75-89. • Saint, et al. Condom versus indwelling urinary catheters: a randomized control trial. JAGS 2006.54(7):1055-1061. • Stahlmann & Lode. Safety considerations of fluoroquinolones in the elderly: an update. Drugs Aging 2010. 27(3):193-209. • Stone, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer Criteria. Infection Control and Hospital Epidemiology 2012.33(10):965-977.

  12. THANK YOU

  13. 2012 REVISED MCGEER CRITERIA Acute dysuria or acute painful teste/epidid/prostate OR Fever* or WBC>11 AND 1 urinary sx: - Acute CVAT -Suprapubicpain - Gross hematuria • - New/incontinence • - New/urgency • - New/frequency OR 2 localizing urinary sx UCx >105CFU/mL(2 bugs) OR 102 CFU/mL any bugs (catheterized) Fever*, rigors, acute hypotension (no alt source) OR AMS/Acute functional decline + WBC >11 OR Acute suprapubic pain or CVAT OR Catheter purulent discharge or acute painful teste/epidid/prostate (Indwelling catheter) UCx >105CFU/mL (collect from new cath if >14d)

More Related