title: [Diaper cystitis as recurrent cause of urinary infections in geriatric community hospital].
abstract: OBJECTIVE
  Chronic cystitis in diaper-dependent elderly patients can be a causative pathology for recurrent urinary tract infections (UTIs) in community hospitals.
  
  
  METHODS
  We analyzed hospital infections to determine causative organisms from January 2007 to December 2009 in patients in a long-term care hospital. The reading causes of hospital infections were UTIs (30.4%), aspiration pneumonia (CAP; 26%) and hospital-acquired pneumonia (HAP; 17.2%). Of a total of 3,097 hospital infections over the investigation period, UTIs were the most common (n=940, 30.4%) followed by CAP (n=809, 26%) and HAP (n=533, 17.2%). Of 278 UTIs in 2007, the causative strains were Escherichia coli (n=106, 38%), Enterococcus faecalis (n=44, 16%), Proteus mirabilis (n=31, 11%), α-hemolytic streptococcus (n=22, 8%), and β-hemolytic streptococcus (n=14, 5%). Extended spectrum β-lactamase (n=14, 13%) strains were noted in 106 patients with Escherichia coli. We then retrospectively examined the records of 110 diaper dependent elderly patients, (medical words, n=52, mix-care wards, n=68) for UTIs over the same study period. Of these 16 (14.5%) had no UTIs at any time, 12 (11%) were infected 50% of the time, 17 (15.5%) were infected 51% to 99% of the time and 65 (59%) were infected 100% of the time. The UTI rate was not correlated with bladder function or between the 2 wards. We treated bacterial cystitis with antibiotics for 3-5 days but these were unsuccessful. Antiseptics worked temporarily, but recurrence or re-infection always occurred. It remains unknown if diapers are a potential cause of chronic cystitis in dependent elderly patients. The clinical dilemma of whether recurrent diaper cystitis should be treated and prohibit the growth and spread of drug-resistant strains, remains challenging.
authors.affiliation: Division of Geriatric Medicine and Urology, Kitakyushu-Koga Hospital.
authors.forename: Eiji
authors.initials: E
authors.lastname: Iwatsubo
mesh_terms: D000368:Aged; D003428:Cross Infection / Q000209:etiology*; D003556:Cystitis / Q000150:complications*; D041382:Diapers, Adult / Q000009:adverse effects*; D005260:Female; D006763:Hospitals, Chronic Disease; D006801:Humans; D008297:Male; D012008:Recurrence; D014552:Urinary Tract Infections / Q000209:etiology*