Urinary tract infections in long-term care

Urinary tract infections (UTIs) are the most common cause of bacteremia in long-term care (LTC) patients and may present with subtle nonspecific symptoms. UTIs should be suspected in older adults in LTC who manifest a sudden problem with incontinence, decreased physical or cognitive function, or loss of appetite. When a UTI is suspected, empiric antibiotics should be started based on the local infection pattern. Typically, trimethoprim/sulfamethoxazole is the major first-line empiric agent. Antibiotic prophylaxis to prevent UTIs may be required in postmenopausal women with frequent recurrent UTIs, patients about to undergo urologic or gynecologic procedures, patients with spinal cord injury, and men with chronic bacterial prostatitis. Although the high incidence of bacteriuria exists with the use of indwelling catheters, antibiotic prophylaxis is not recommended. Because asymptomatic bacteriuria does not require treatment, there is no role for periodic urine cultures in the chronically catheterized patient.