DOES ERADICATING BACTERIURIA AFFECT THE SEVERITY OF CHRONIC URINARY-INCONTINENCE IN NURSING-HOME RESIDENTS

Objective: To determine the effects of eradicating otherwise asymptoma tic bacteriuria on the severity of chronic urinary incontinence among nursing home residents. Design: Residents were categorized as nonbacte riuric or bacteriuric on the basis of urine cultures. Bacteriuric resi dents were then randomly assigned to immediate and delayed treatment g roups. The delayed treatment group was included to control for spontan eous changes in the severity of incontinence. The immediate treatment group received antimicrobial therapy for 7 days; after outcome measure s had been repeated, the delayed treatment group was treated. Setting: 6 community-based nursing homes. Patients: Nursing home residents wit h chronic urinary incontinence. Measurements: The frequency and volume of urinary incontinence were determined by physical checks for wetnes s by trained research aides hourly between 7 a.m. and 7 p.m. for 3 day s in all patient groups (nonbacteriuric, bacteriuric with immediate tr eatment, and bacteriuric with delayed treatment) at baseline, after th e immediate treatment group was treated, and again after the delayed t reatment group was treated. Results: 191 residents were enrolled, and 176 completed the study. Bacteriuria was eradicated by antimicrobial t herapy in 71 residents (40%), and 17 residents (10%) had bacteriuria b efore and after therapy. The percentage of hourly checks at which the residents were found wet and other measures of incontinence severity r emained essentially the same after bacteriuria was eradicated. In the nonbacteriuric group, the percentage of checks that were wet increased from 29% (95% Cl, 26% to 32%) at baseline to 30% (Cl, 27% to 34%) on repeated measurement. In the bacteriuric groups, the percentage increa sed from 34% (Cl, 30% to 38%) before treatment to 35% (Cl, 31% to 39%) after bacteriuria was eradicated. The presence of pyuria did not affe ct the results. Conclusion: Eradicating bacteriuria has no short-term effects on the severity of chronic urinary incontinence among nursing home residents. Our data support the practice of not treating asymptom atic bacteriuria in this population and validate the recommendations i n the Health Care Financing Administration's Resident Assessment Proto col for urinary incontinence.