title: Urinary tract infection diagnosis and response to therapy in long-term care: A prospective observational study.
abstract: BACKGROUND
  The prevalence of asymptomatic bacteriuria among residents of long-term care (LTC) facilities is high, and is a source of inappropriate antibiotic prescription.
  
  
  OBJECTIVE
  To establish symptoms and signs associated with a positive urine culture, and to determine whether antibiotic therapy is associated with functional improvement.
  
  
  METHODS
  A total of 101 LTC patients were prospectively observed after submission of urine for culture.
  
  
  RESULTS
  The culture positivity rate was consistent with the expected asymptomatic bacteriuria rate. Change in mental status and male sex were associated with culture positivity. Treatment decisions were not consistent with culture results. Treatment did not lead to improvement in activities of daily living scores at two days or seven days.
  
  
  CONCLUSIONS
  Significant growth cannot be well predicted based on clinical variables; thus, the decision to submit urine is somewhat arbitrary. Because urine culture testing and treatment does not lead to functional improvement, restricting access to the test may be reasonable.
  
  
  CONCLUSIONS
  Urine culture testing in LTC facilities does not lead to functional improvement.
authors.affiliation: Memorial University, Winnipeg, Manitoba;
authors.forename: Peter
authors.initials: P
authors.lastname: Daley
authors.affiliation: Memorial University, Winnipeg, Manitoba;
authors.forename: Carla
authors.initials: C
authors.lastname: Penney
authors.affiliation: Memorial University, Winnipeg, Manitoba;
authors.forename: Susan
authors.initials: S
authors.lastname: Wakeham
authors.affiliation: Long-Term Care, Eastern Health, St John's, Newfoundland and Labrador, Winnipeg, Manitoba;
authors.forename: Glenda
authors.initials: G
authors.lastname: Compton
authors.affiliation: Long-Term Care, Eastern Health, St John's, Newfoundland and Labrador, Winnipeg, Manitoba;
authors.forename: Aaron
authors.initials: A
authors.lastname: McKim
authors.affiliation: Long-Term Care, Eastern Health, St John's, Newfoundland and Labrador, Winnipeg, Manitoba;
authors.forename: Judy
authors.initials: J
authors.lastname: O'Keefe
authors.affiliation: Memorial University, Winnipeg, Manitoba;
authors.forename: Brendan
authors.initials: B
authors.lastname: Barrett
authors.affiliation: University of Manitoba, Winnipeg, Manitoba.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Nicolle
keywords: Antibiotic stewardship; Asymptomatic bacteriuria; Diagnosis; Long-term care; Urinary tract infection