Urinary tract infection in long-term-care facility residents

Urinary tract infection is the most frequent bacterial infection in residen ts of long-term-care facilities. Most infections are asymptomatic, with a r emarkable prevalence of asymptomatic bacteriuria of 15%-50% among all resid ents. The major reasons for this high prevalence are chronic comorbid illne sses with neurogenic bladder and interventions to manage incontinence, Pros pective, randomized, comparative trials of therapy and no therapy for asymp tomatic bacteriuria among nursing home residents have repeatedly documented that antimicrobial treatment had no benefits. However, there is substantia l diagnostic uncertainty in determining whether an individual with a positi ve urine culture has symptomatic or asymptomatic infection when there is cl inical deterioration and there are no localized findings. In the noncathete rized resident, urinary infection is an infrequent source of fever but may not be definitively excluded. The use of antimicrobials for treatment of ur inary infection is part of the larger concern about appropriate antimicrobi al use in long-term-care facilities and the impacts of the selective pressu re of antimicrobials on colonization and infection with resistant organisms .