Empiric antibiotic treatment for lower urinary tract infections in nursing home residents: 54 months observational study

Urinary tract infections (UTI) are the most common infection in institutionalized elderly. The issue of empirical treatment of infections is of great importance in elderly residents of nursing homes where the high incidence of UTI is associated with very high resistance rates. Aim of the work was to verify which of the antibiotics included in the routine susceptibility testing performed by our reference laboratory, could allow an empirical treatment of UTI, based on the sensitivity of strain susceptibility. We conducted a 54 months active surveillance of urinary tract infections in RSA Villa San Clemente Villasanta (MB), recording the sensitivity to each antibiotic, evaluated in a qualitative way ("S" Susceptible; "MS" moderately susceptible; "R" resistant). Data were accrued about 19 antibiotics, but only eight of them tested in more than 90% of cases and were considered for statistical analysis. Among the antibiotics evaluated, only imipenem-ciclastina appeared to be sufficiently reliable in case of empirical treatment. However considering route of administration, possible emergence of resistance and the high cost, we believe that assessment of urine culture with susceptibility testing remains the most effective and safe strategy for the choice of antibiotics for UTI in elderly residents of nursing home.