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Re: Urine Cultures From Indwelling Bladder Catheters in Nursing Home Patients: A Point Prevalence Study in a Swedish County
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GERIATRICS
person-year) and other infections (0.20 per person-year). Incidence risk ratios were obtained by a multiplicative Poisson regression model. There was a J-shaped curve in the incidence of infections recorded by BMI with a nadir at 27–28 kg/m2. Compared with the reference group with a BMI of 24 –27.9 kg/m2, subjects with a lower BMI had a higher incidence rate of infections. The incidence risk ratios, adjusted for sex, age and chronic diseases, were 1.62 (95 % CI 1.21, 2.17) for those with a BMI of ⬍ 20 kg/m2 and 1.84 (95 % CI 1.40, 2.42) for those with a BMI of 20 –23.9 kg/m2. However, also patients with a BMI of 28 kg/m2 and above had a higher incidence rate of infections, with an incidence risk ratio of 1.54 (95 % CI 1.07, 2.22). These results show that both underweight and obesity are associated with a higher risk of infections in institutionalised geriatric patients. Editorial Comment: Obesity has been linked to a variety of negative health conditions, including coronary artery disease, diabetes, hypertension, stroke and arthritis. Some surgical studies looking at several variables have shown that obese elderly patients actually fare better than those who are underweight, perhaps due to increased functional reserve capacity. In contrast, there have been few studies examining the associations between body mass index and infectious outcomes, particularly in older adults. Nosocomial infections are common in institutional settings. In this study urinary tract infection was by far the leading type of infection seen in the institutionalized geriatric population. It is noteworthy that obese and significantly underweight elders were more likely to experience clinically significant infections. These results highlight the importance of proper nutrition and body composition to maintain overall condition, including urological health. Tomas L. Griebling, M.D., M.P.H.
Re: Urine Cultures From Indwelling Bladder Catheters in Nursing Home Patients: A Point Prevalence Study in a Swedish County K. Jonsson, B. E. Claesson and H. Hedelin Departments of Research and Development, and Clinical Microbiology, Unilabs, Skaraborgs, Skövde, Sweden Scand J Urol Nephrol 2011; 45: 265–269.
Objectives: To survey the bacterial flora and antibiotic resistance in urinary strains from patients with indwelling bladder catheters residing in nursing homes within a geographically defined region. Material and methods. Urine was sampled for culture from 163 catheter patients (126 men and 37 women) during a 2 week period in March 2010. Susceptibility testing of the isolated bacteria was compared with all urinary strains (n ⫽ 9994) from hospitals and primary healthcare in the same geographical area cultured during the first 6 months of 2010 (control group). Results: Bacteriuria was found in 159 of 163 urine samples (98%). Enterococcus faecalis and Escherichia coli were the most common species, one or both being detected in 72% of the urine samples, while Proteus species were found in10% and a single isolate of Providentia species was seen. Strains in the study patients were more resistant to antibiotics than in the control group. Particularly large differences were noted for ciprofloxacin in E. coli (16.9% vs 7.9%) and for trimethoprim-sulfamethoxazole in E. faecalis (39.1% vs 24.8%). One extended spectrum -lactamase (ESBL)-producing E. coli was cultured (1.3%), compared with 1.6% in the control group. No vancomycin-resistant enterococci (VRE) or methicillin-resistant Staphylococcus aureus (MRSA) were detected. Conclusions: Proteus mirabilis and Providentia species were rarely isolated, in sharp contrast to previous studies from geriatric hospital wards where they have often been in the majority. The limited incidence of ESBL and the absence of VRE and MRSA is gratifying, but the high resistance to antibiotics needs to be assessed on a continuous basis. Editorial Comment: The use of indwelling urinary catheters to manage incontinence and other genitourinary problems in elderly nursing home residents has decreased significantly in recent years. This change is due in large part to an increased understanding of the risks associated with indwelling catheter use, including bacterial colonization, uroli-
GERIATRICS
2269
thiasis, squamous metaplasia and squamous cell carcinoma, and structural damage due to tissue erosion. However, in some cases use of an indwelling catheter is the only feasible option for management of the specific urological condition. Urinary tract bacterial colonization is common and has been associated with a variety of negative outcomes, including increased mortality. This study examined the prevalence of specific bacterial flora and the degree of antibiotic resistance in a cohort of 136 elderly nursing home residents with indwelling catheters in a localized region in Sweden. Data were compared to urine culture and susceptibility results from hospitals and primary care clinics in the same geographical region during the same time frame. Bacterial colonization was seen in 98% of the nursing home subjects with catheters. The most striking finding was the high rate of antibiotic resistant organisms compared to the control group. The results underscore the importance of avoiding indwelling catheter use if possible, particularly in elderly institutionalized patients. In those who require indwelling catheters routine use of antibiotics should be avoided to help reduce the development of resistant bacterial strains. Tomas L. Griebling, M.D, M.P.H.
GERIATRICS
person-year) and other infections (0.20 per person-year). Incidence risk ratios were obtained by a multiplicative Poisson regression model. There was a J-shaped curve in the incidence of infections recorded by BMI with a nadir at 27–28 kg/m2. Compared with the reference group with a BMI of 24 –27.9 kg/m2, subjects with a lower BMI had a higher incidence rate of infections. The incidence risk ratios, adjusted for sex, age and chronic diseases, were 1.62 (95 % CI 1.21, 2.17) for those with a BMI of ⬍ 20 kg/m2 and 1.84 (95 % CI 1.40, 2.42) for those with a BMI of 20 –23.9 kg/m2. However, also patients with a BMI of 28 kg/m2 and above had a higher incidence rate of infections, with an incidence risk ratio of 1.54 (95 % CI 1.07, 2.22). These results show that both underweight and obesity are associated with a higher risk of infections in institutionalised geriatric patients. Editorial Comment: Obesity has been linked to a variety of negative health conditions, including coronary artery disease, diabetes, hypertension, stroke and arthritis. Some surgical studies looking at several variables have shown that obese elderly patients actually fare better than those who are underweight, perhaps due to increased functional reserve capacity. In contrast, there have been few studies examining the associations between body mass index and infectious outcomes, particularly in older adults. Nosocomial infections are common in institutional settings. In this study urinary tract infection was by far the leading type of infection seen in the institutionalized geriatric population. It is noteworthy that obese and significantly underweight elders were more likely to experience clinically significant infections. These results highlight the importance of proper nutrition and body composition to maintain overall condition, including urological health. Tomas L. Griebling, M.D., M.P.H.
Re: Urine Cultures From Indwelling Bladder Catheters in Nursing Home Patients: A Point Prevalence Study in a Swedish County K. Jonsson, B. E. Claesson and H. Hedelin Departments of Research and Development, and Clinical Microbiology, Unilabs, Skaraborgs, Skövde, Sweden Scand J Urol Nephrol 2011; 45: 265–269.
Objectives: To survey the bacterial flora and antibiotic resistance in urinary strains from patients with indwelling bladder catheters residing in nursing homes within a geographically defined region. Material and methods. Urine was sampled for culture from 163 catheter patients (126 men and 37 women) during a 2 week period in March 2010. Susceptibility testing of the isolated bacteria was compared with all urinary strains (n ⫽ 9994) from hospitals and primary healthcare in the same geographical area cultured during the first 6 months of 2010 (control group). Results: Bacteriuria was found in 159 of 163 urine samples (98%). Enterococcus faecalis and Escherichia coli were the most common species, one or both being detected in 72% of the urine samples, while Proteus species were found in10% and a single isolate of Providentia species was seen. Strains in the study patients were more resistant to antibiotics than in the control group. Particularly large differences were noted for ciprofloxacin in E. coli (16.9% vs 7.9%) and for trimethoprim-sulfamethoxazole in E. faecalis (39.1% vs 24.8%). One extended spectrum -lactamase (ESBL)-producing E. coli was cultured (1.3%), compared with 1.6% in the control group. No vancomycin-resistant enterococci (VRE) or methicillin-resistant Staphylococcus aureus (MRSA) were detected. Conclusions: Proteus mirabilis and Providentia species were rarely isolated, in sharp contrast to previous studies from geriatric hospital wards where they have often been in the majority. The limited incidence of ESBL and the absence of VRE and MRSA is gratifying, but the high resistance to antibiotics needs to be assessed on a continuous basis. Editorial Comment: The use of indwelling urinary catheters to manage incontinence and other genitourinary problems in elderly nursing home residents has decreased significantly in recent years. This change is due in large part to an increased understanding of the risks associated with indwelling catheter use, including bacterial colonization, uroli-
GERIATRICS
2269
thiasis, squamous metaplasia and squamous cell carcinoma, and structural damage due to tissue erosion. However, in some cases use of an indwelling catheter is the only feasible option for management of the specific urological condition. Urinary tract bacterial colonization is common and has been associated with a variety of negative outcomes, including increased mortality. This study examined the prevalence of specific bacterial flora and the degree of antibiotic resistance in a cohort of 136 elderly nursing home residents with indwelling catheters in a localized region in Sweden. Data were compared to urine culture and susceptibility results from hospitals and primary care clinics in the same geographical region during the same time frame. Bacterial colonization was seen in 98% of the nursing home subjects with catheters. The most striking finding was the high rate of antibiotic resistant organisms compared to the control group. The results underscore the importance of avoiding indwelling catheter use if possible, particularly in elderly institutionalized patients. In those who require indwelling catheters routine use of antibiotics should be avoided to help reduce the development of resistant bacterial strains. Tomas L. Griebling, M.D, M.P.H.