Understanding Urinary Tract Infections Focus on Prevention,John Gotelli, NP University of North Carolina Health Care,Continuing Nursing Education (CNE) Credit,CCME is accredited as an approved provider of CNE by the North Carolina Nurses Association, an accredited approver of continuing nursing education by the American Nurses Credentialing Centers Commission on Accreditation.CCME utilizes industry accepted mechanisms to identify and resolve conflicts of interest. The planners, faculty, and speakers for this activity have no unresolved relevant financial relationships with commercial interests that could be perceived as a conflict of interest.CCME has received no commercial support related to this educational activity.,Approved by CCME for 1.0 Contact Hour of CNE Credit,To Obtain CreditRegister and attend webinarComplete survey evaluation questions before you leave the webinarComplete attendance verification through the SurveyMonkey tool by September 25, the expiration date for awarding contact hours CCME will then provide you with an attendance certificate for your records,Objectives,Learn geriatric “pearls” in identifying, preventing and treating Urinary Tract Infections (UTIs) in elderly Review antibiotic treatment guidelines for UTIs in elderly Discuss techniques in preventing both complicated and uncomplicated UTIs in elderly Understand risks associated with use of Indwelling Urinary (foley) catheters Differentiate between asymptomatic bacteriuria and Urinary Tract Infection (UTI),Introduction - Definitions,Urinary Tract Infection (UTI) aka Acute Uncomplicated Cystitis infection of the bladder (lower urinary tract) Pyelonephritis infection of the upper urinary tract (ureters / renal collecting system / kidneys). Asymptomatic Bacteriuria Isolation of a specific count of bacteria in a urine specimen from an individual w/o signs or symptoms of UTI,Definitions, cont,Note These may be localized to either lower or upper urinary tract Complicated UTI (cystitis) Diabetes Pregnancy H/O pyelo Hospital acquired infection Urinary Tract Obstruction (men) Catheter (or recent catheterization in prior 48 hours) Childhood h/o UTIs Immunosuppression Renal Transplant,Definitions, cont,Long Term Care Facility (LTC)“Encompasses an array of medical, social, personal and supportive specialized housing for individuals who have lost some capacity for self care due to illness / disabling condition” (Family Care Giving Alliance, 2000)ADL / IADL support Medicare / Medicaid,Definitions, cont,Population 63% are 65 or Current population in LTC is 6.3 million By 2050 total number of individuals needing paid LTC/Institutional LTC will double to around 27 million Infection / Illness often times presents differently in aged lack of fever / blunted white cell count / mental status changes / functional decline / anorexia / agitation,UTI in Long Term Care Facility,Primary cause of bacteremia in LTC residents is due to UTIs Incidence of symptomatic UTIs in elderly in LTC around 10% Prevalence of asymptomatic bacteriuria in women approx. 30% and 10% in men Why so common?,UTI in Long Term Care Facility, cont,Risk Factors Physiologic changes of bladder / urethral flora w/ age (post/menopausal women) Use of indwelling catheters Congregate living Functional / Cognitive Impairment Decrease self care Decrease cues to void Difficulty finding bathroom / suitable location to void ?Elevated Post Void Residual Volume of Urine?,Urinary Tract Infections (uncomplicated),Diagnosis Symptoms dysuria, suprapubic pain,frequency,urgency,hematuria + clean catch culture growing _ 10 (3) cfu/ml of no more than 2 species of uropathogens (Barber, et al 2013)CDC Alternative Definition 2 of following (a) Fever ( 38c), dysuria, frequency, urgency, or suprapubic pain AND at least one of following: + gram stain, pyuria _10wbc/ml, +Leukocyte Esterace (b)AND/OR nitrite by dipstick, or 2 + urine cultures w/ same uropathogen _ 10 (2) in a non voided sample,Urinary Tract Infection (uncomplicated),Resistance can be high e. coli resistance to trimethoprim/sulfamethoxazole and cipro ranged from as high as 45% for bactrim and 13% for cipro. Length for uncomplicated UTI in elderly women favors short course (3-6 days). For men 7 to 14 days 2010 IDSA guidelines suggest nitrofurantoin 100mg bid x 5 days or trimethoprim / sulfamethoxazole 160/80 bid x 3 days for initial empiric therapy My Clinical practice is cipro 250 bid x 3 days Some (Mouten, 2010) suggest all elderly should receive 7 to 14 day treatment Parenteral therapy for clinically unstable patients or those presenting as very ill - 3rd generation cephalosporin w/ hospital admission (IV ceftazadime),Complicated Urinary Tract Infection: Indwelling Urinary Catheter,Big deal in hospital #1 site of HAI 15% to 25% of hospitalized patients get a catheter Estimated 13,000 attributable deaths / year Increases LOS by 2-4 days Incidence of bacteriuria is 3% to 8% per day In LTC 7.5% to 10% Often times unclear indications for use Care givers become lax in approach to catheter care Infection usually occurs at time of insertion / extra/ intraluminal migration of bacteria.,