RISK-FACTORS AND CONSEQUENCES OF BACTERIURIA IN NON-CATHETERIZED NURSING-HOME RESIDENTS

Background. There has been disagreement over the significance of bacte riuria in nursing home residents. Methods. During an 18-month period, the risks and consequences of bacteriuria (BU) in 195 residents of a s killed nursing facility without indwelling catheters were examined. Cl inical and epidemiologic data and urine for culture were collected eve ry 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 ''pers istent BU'' defined as > 10(5) cfu/ml of urine on >25% of an individua l's collected cultures. Women with persistent BU more frequently were incontinent of bowel and bladder (OR 5.3, 6.3, respectively), more lik ely to be functionally disabled (OR 3.2), to carry a diagnosis of deme ntia (OR 2.4), and less likely to have suffered a stroke (OR 0.40). Ca ncer (OR 6.5) was the only risk factor for persistent BU in men. The n umber 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 incon tinence and functional disability with persistent bacteriuria suggests that treatment or prevention of these risk factors may prevent or dec rease the incidence of bacteriuria. There was no evidence of significa nt adverse outcomes resulting directly from the bacteriuric state. Hig her mortality in the bacteriuric group was the result of underlying fu nctional debility and severity of illness rather than the presence or persistence of BU.