Journal of Gerontological Nursing, 2013;30(6):4–9
Abstract
Urine odor may be misleading in detecting urinary tract infections in elderly nursing home residents.
ABSTRACT
Asymptomatic bacteriuria is considered a transient and benign condition in the geriatric population. Before a diagnosis of a urinary tract infection (UTI) can be made, symptoms and significant bacteriuria must be present. One of these symptoms is malodorous urine. Other symptoms of a UTI, typical in the younger population, have been found to be absent or misleading in the older adult population. Though early detection of UTIs improves outcomes, unnecessary laboratory tests are costly and time-consuming, and may encourage inappropriate antibiotic therapy. The purpose of this study was to determine if urine odor is an accurate predictor of a UTI in the older adult incontinent nursing home population. Ninety-seven recently wet incontinence pads of residents in six Midwestern nursing homes were evaluated for odor within 1 hour of voiding. These results were compared to microscopy and culture results of clean-catch urine samples from these individuals. Defining a UTI as either bacteriuria or bacteriuria and pyuria, using urine odor to identify a UTI resulted in error in one third of cases. Results of this study indicate smell of urine in incontinence pads may be an absent or misleading symptom for UTIs in elderly nursing home residents.
- Abrutyn, E., Mossey, J., Berlin, J., Boscia, J., Levison, M., Pitsakis, P., & Kaye, D. (1994). Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women? Annals of Internal Medicine, 120(10), 827-835. Google Scholar
- Ahmad, T., Vickers, D., Campbell, S., Coulthard, M., & Pedler, S. (1991). Urine collection from disposable nappies. The Lancet, 338, 674-676. Google Scholar
- Baldassarre, J., & Kaye, D. (1991). Special problems of urinary tract infection in the elderly. Medical Clinics of North America, 75(2), 375-390. Google Scholar
- Barkhara, T., Martin, F., & Eykyn, S. (1996). Delay in diagnosis of bacteraemic urinary tract infection in elderly patients. Age and Ageing, 2 J, 130-132. Google Scholar
- Barnett, BJn & Stephens, D.S. (1997). Urinary tract infection: An overview. American Journal of Medical Science, 314(A), 245-249. Google Scholar
- Bentley, D., Bradley, S., High, K., Schoenbaum, S., Taler, G., & Yoshikawa T. (ZOOl). Practice guidelines for evaluation of £ever and infection in long-term care facilities. Journal of the American Geriatrics Society, 49(2), 210-222. Google Scholar
- Berman, P., Hogan, D., & Fox, R. (1987). The atypical presentation of infection in old age. Age and Ageing, 16, 201-207. Google Scholar
- Blumberg, E., & Abrutyn, E. (1997). Methods for the reduction of urinary tract infection. Current Opinion in Urology, 7, 47-51. Google Scholar
- Boscia, J., Kobasa, W., Abrutyn, E., Levison, M., Kaplan, A., & Kaye, D. (1986). Lack of association of bacteriuria and symptoms in the elderly. American Journal of Medicine; 81, 979-982. Google Scholar
- Breitenbucher, R. (1990). UTI: Managing the most common nursing home infection. Geriatria, 45(5), 68 -71. Google Scholar
- Brooks, S., Warshaw, G., Hasse, L., & Kues, J. (1994). The physician decision-making process in transferring nursing home patients to the hospital. Archives of Internal Medicine, IH, 902-908. Google Scholar
- Brunzel, N. (1994). Fundamentals of urine and body fluid analysis. Philadelphia, PA: W.B. Saunders. Google Scholar
- Castle, S., Norman, D., Yeh, M., Miller, D., & Yoshikawa, T. (1991). Fever response in elderly nursing home residents: Are the older truly colder? Journal of the American Geriatrics Society, 39, 853-857. Google Scholar
- Colling, J., McCreedy, M., & Owen, T. (1994). Urinary tract infection rates among incontinent nursing home and community dwelling elderly. Urologie Nursing, /4(3), 117-119. Google Scholar
- Edwards, A., van der Voort, J., Newcombe, R., Thayer, H., & Jones, K. (1997). A urine analysis suitable for children's nappies. Journal of Clinical Pathology, 50, 569-571. Google Scholar
- Ehrlich, E., Flexner, S., Carruth, G., & Hawkins,]. (1980). Oxford American dictionary. New York: Avon Books. Google Scholar
- Esposito, A., Gleckman, R., Cram, S., Crowley, M., McCabe, F, & Drapkin, M. (1980). Community-acquired bacteremia in the elderly: Analysis of 100 consecutive episodes. Journal of the American Geriatrics Society, 28(7), 315-319. Google Scholar
- Fontanarosa, P., Kaeberlein, E, Gerson, L., & Thomson, R. (1992). Difficulty in predicting bacteremia in elderly emergency patients. Annals of Emergency Medicine, 21(7), 842-848. Google Scholar
- Garner, J., Jarvis, W., Emori, T., Horanm, T., & Hughes, J. (1988). CDC definitions for nosocomial infections. Journal of Infection Control, 16, 128-140. Google Scholar
- Gleckman, R., Blagg, N., Hibert, B., Hall, A., Crowley, M., Pritchard, A., & Warren, W. (1982). Acute pyelonephritis in the elderly. Southern Medical Journal, 75(5), 551-554. Google Scholar
- Gorbach, S., & Bartlett, J. (1974). Anaerobic infections. New England Journal of Mediane, 290(22), 1237-1244. Google Scholar
- Gruneberg, N., & Bendali, M. (1979). Hospital outbreak of trimethoprim resistance in pathogenic coliform bacteria. British Medical Journal, 2(1681), 7-9. Google Scholar
- Jackson, M., Fierer, J., Barrett-Connor, E., Fraser, D., Klauber, M., Hatch, R., Burkhart, B., & Jones, M. (1992). Intensive surveillance for infections in a 3 -year study of nursing home patients. American Journal of Epidemiology, 135(6), 685-695. Google Scholar
- Johnson, C. (1991). Definitions, classifications and clinical presentation of urinary tract infections. Medical Clinics of North America, 79(2), 241-245. Google Scholar
- Karafin, L., & Coll, M. (1987). Lower urinary tract disorders in the postmenopausal woman. Medical Clinics of North America, 71(1), 111-121. Google Scholar
- Kavic, S., & Cohn, S. (1996). Letter to the editor. The Journal of Trauma, Injury, Infection, and Critical Care, 41(6), 1077. Google Scholar
- Lamberg, S., & Rothstein, R. (1978). Hematology and urinalysis (3rd ed.). Westport, CT: AVI Publishing Company. Google Scholar
- McGeer, A., Campbell, B., Emori, T., Hierholzer, W., Jackson, M., Nicolle, L., Peppier, C, Rivera, A., Schollenberger, D., Simor, A., Smith, P., & Wang, E. (1991). Definitions of infection for surveillance in long-term care facilities. American Journal of Infection Control, 19(1), 1-7. Google Scholar
- Meislin, H. (1986). Pathogenic identification of abscesses and cellulitis. Annals of Internal Medicine, 15, 329-332. Google Scholar
- Millette-Petit, J. (1988). Urinary tract infections in older adults. Nurse Practitioner, 13(12), 21-24, 29. Google Scholar
- Nakar, S., Kahan, E., & Weingarten, M. (1994). Can you smell the strep? The Lancet, 343, 729-730. Google Scholar
- Nicolle, L. (1993). Urinary tract infection in long-term care facilities. Infection Control and Hospital Epidemiology, 14, 220-225. Google Scholar
- Nicolle, L. (1994). Urinary tract infection in the elderly. Journal of Antimicrobial Chemotherapy, JJ(Suppl. A), 99-109. Google Scholar
- Nicolle, L., Bentley, D., Garbaldi, R., Neuhaus, E., & Smith, P. (1996). Antimicrobial use in long-term-care facilities. Infection Control and Hospital Epidemiology, 17(2), 119-128. Google Scholar
- Ouslander, J. (1989). Medicai care in the nursing home. Journal of the American Medical Association, 262(18), 2582-2590. Google Scholar
- Ouslander, J., Shapira, M., & Schnelle, J. (1995). Urine specimen collection from incontinent female nursing home residents. Journal of the American Geriatrics Society, 4? 279-281. Google Scholar
- Smith, P. (1998). Nursing home infection control: A status report. Infection Control and Hospital Epidemiology, 19, 366-369. Google Scholar
- Stamm, W. (1983). Measurement of pyuria and its relation to bacteriuria. The American Journal of Mediane, 7.5(1B), 53-58. Google Scholar
- Summers, D., & Rundell, M. (Eds.). (1987). Longman dictionary of contemporary English (2nd ed.).Suffolk, England: Richard Clay Ltd. Google Scholar
- Webster's dictionary. (1997). Ashland, OH: Landoll, Inc. Google Scholar
- Winn, W. (1993). Editorial. Diagnosis of urinary tract infection: A modern procrustean bed. American Journal of Clinical Pathology, 99, 117-11 9. Google Scholar
- Yoshikawa, T. (1984). Unique aspects of urinary tract infection in the geriatric population. Gerontology, 30, 339-344. Google Scholar
