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Asymptomatic bacteriuria in older adults: the most fragile women are prone to long-term colonization

Michael Biggel1, Stefan Heytens2, Katrien Latour3,4

  • 1Laboratory of Medical Microbiology, University of Antwerp, Universiteitsplein 1, building S, 2610 Wilrijk, Antwerp, Belgium.

BMC Geriatrics
|June 23, 2019
PubMed
Abstract

Insights

Asymptomatic bacteriuria (ABU) affects 40% of older adults in long-term care, with frail women experiencing higher rates. Identifying ABU risk factors is crucial to prevent unnecessary antibiotic use for urinary tract infections (UTIs).

Area of Science:

  • Gerontology
  • Infectious Diseases
  • Urology

Background:

  • Urinary tract infection (UTI) diagnosis in institutionalized older adults often relies on vague symptoms and positive cultures.
  • High prevalence of asymptomatic bacteriuria (ABU) is frequently overlooked, leading to antibiotic overuse.
  • Distinguishing ABU from acute UTIs in this population is challenging.

Purpose of the Study:

  • To identify subpopulations of institutionalized older adults predisposed to transient or long-term asymptomatic bacteriuria (ABU).

Main Methods:

  • Screening of residents in a long-term care facility for ABU.
  • Collection of mid-stream urine samples in two rounds, 10 weeks apart, with initial and confirmatory samples.
  • Utilizing a scale assessing functional independence to predict ABU.

Main Results:

  • Approximately 40% of participants had ABU, predominantly caused by Escherichia coli.
  • Long-term ABU (over 3 months) was observed in 30% of subjects.
  • Frailest women with urinary incontinence and dementia showed significantly higher ABU rates, particularly long-term ABU.

Conclusions:

  • Institutionalized women with incontinence exhibit high ABU prevalence (around 80%) and may be persistent carriers.
  • High ABU prevalence rates necessitate re-evaluation of urine culture's diagnostic value for UTIs in this demographic.
  • Urgent need for diagnostic strategies to prevent antibiotic overuse and identify patients at risk for upper UTIs.
Keywords:
Asymptomatic bacteriuriaOlder adultsUrinary tract infection

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