Jg. Ouslander et al., DOES ERADICATING BACTERIURIA AFFECT THE SEVERITY OF CHRONIC URINARY-INCONTINENCE IN NURSING-HOME RESIDENTS, Annals of internal medicine, 122(10), 1995, pp. 749-754
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.