Confusion Strongly Associated with Antibiotic Prescribing Due to Suspected Urinary Tract Infections in Nursing Homes.

OBJECTIVES

To quantify the prevalence of documented urinary tract infection (UTI), nonspecific symptoms, and antibiotic treatment of suspected UTI in nursing homes (NHs) in the tropics and to describe the typical resident likely to receive antibiotic treatment for suspected UTI and factors associated with the development of confusion, fatigue, and restlessness.

DESIGN

Cross-sectional.

SETTING

Five far north Queensland NHs in tropical Australia.

PARTICIPANTS

NH residents (N = 450).

MEASUREMENTS

Chart reviews of NH residents between August 28, 2015, and June 21, 2016, to determine the prevalence of documented UTI, new or worsening nonspecific and specific symptoms that are specific or nonspecific to the urinary tract, antibiotic use, medical conditions, and medication factors.

RESULTS

UTI accounted for 33% of all current infections treated with antibiotics and 40% of all infections treated with antibiotics within the last 30 days. One in 5 NH residents had received antibiotics within the last 30 days, of which 45% were for UTI. The most significant factors independently associated with antibiotics for UTI were urinary catheter (OR = 13, 95% CI = 2.4-67, P = .003), urinary frequency (OR = 10, 95% CI = 2.2-47, P = .003), fever (OR = 10, 95% CI = 1.3-85, P = .028), new-onset hypotension (OR = 10, 95% CI = 1.4-73, P = .024), and confusion (OR = 8.9, 95% CI = 3.1-26, P < .001). Of these, confusion was the most prevalent factor in the population.

CONCLUSION

UTI is commonly documented in NH residents, with new or worsening confusion being one of the strongest factors associated with antibiotic treatment for suspected UTI.