GROSS HEMATURIA IN RESIDENTS OF LONG-TERM-CARE FACILITIES

PURPosE: To describe the epidemiology and characteristics of gross hem aturia in elderly residents of nursing homes and to identify the assoc iations of gross hematuria with urinary infection and the potential co ntribution of urinary infection to morbidity. PATIENTS AND METHODS: Th is was a prospective, descriptive study of episodes of gross hematuria identified by the nursing staffs at two long-term-care facilities ove r 2 years. Episodes were characterized with respect to patient variabl es, presence of bacteriuria, duration of hematuria, therapeutic interv entions, and genitourinary investigations. Clinical and serologic crit eria were used to identify invasive infection. RESULTS: The incidence of gross hematuria was 31/100,000 resident days. Bacteriuria was prese nt in 58 (74%) of 78 episodes with evaluable cultures. Fifty-two (61%) episodes lasted more than 24 hours, 25 (29%) were temporally associat ed with fever, and antimicrobials were given for 53 (61%) episodes. Gr oss hematuria occurred more frequently in men than in women and was mo re frequently associated with fever in men. Twenty-four (28%) episodes occurred in subjects with indwelling catheters, 30 (34%) in subjects with known genitourinary abnormalities, 26 (30%) in subjects with no g enitourinary investigations, and 4 (4.6%) in subjects with genitourina ry investigations but no abnormalities identified. No adverse clinical outcomes were identified in patients in whom antimicrobial therapy wa s not initiated. The maximal estimated incidence of invasive urinary i nfection associated with hematuria was 5.8/100,000 resident days, and of bacterial hemorrhagic cystitis, 6.3/100,000 resident days. CONCLUSI ONs: These data suggest that underlying genitourinary abnormalities ar e present in most elderly institutionalized subjects with gross hematu ria when genitourinary investigations are performed. Although bacteriu ria is usually present, urinary infection, by itself, is an infrequent cause of gross hematuria. Afebrile hematuria without irritative sympt oms probably does not require antimicrobial therapy. A standard approa ch to this clinical problem in the institutionalized elderly should be developed to optimize patient management and appropriate use of antim icrobial therapy.