Monitoring urinary tract infections in residents of Australian aged care homes: Clinical and microbiological characteristics identified through a pilot surveillance program

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BACKGROUND: Urinary tract infections (UTIs) are a significant burden among residents of aged care homes (ACHs). The objective of this study was to describe 'UTI event' data reported by Australian ACHs, and to compare clinical and microbiological characteristics with surveillance and clinical case-definitions for UTI. METHODS: Australian ACHs involved in the pilot National Infection Surveillance Program for Aged Care (NISPAC) were offered participation in a pilot study of UTI surveillance. Standardised data collection tools captured resident-days, catheter-days, clinical and microbiological event data. Reported UTI events were evaluated to determine whether criteria for accepted surveillance (Stone/revised McGeer) or clinical (Australian Therapeutic Guideline) UTI case-definitions were met. RESULTS: 136,333 resident days and 4,659 resident catheter-days were submitted by 25 ACHs from five Australian jurisdictions. In total, 172 UTI events with at least one sign or symptom were reported (150 in non-catheterised residents and 21 in catheterised residents), with the most commonly reported being 'new onset confusion or functional decline' (116/172, 67.4%). Almost half (71/150, 47.3%) non-catheterised resident events did not meet either Stone or Therapeutic Guidelines modified case definitions for UTI. Over half (45/89, 50.6%) of urine cultures from non-catheterised residents met laboratory criteria for UTI but lacked sufficient signs or symptoms to fulfil UTI case definitions. CONCLUSION: Nearly half of reported UTI events did not meet surveillance or clinical case-definitions. This highlights the need to support initiatives to improve clinician recognition of UTI, recognise asymptomatic bacteriuria and understand the limitations of relying on urine culture alone to confirm UTI.