Cognitive Impairment, Behavior and UTI Diagnosis in LTC

April 29, 2016    |   By: Alex Christgen, BS, CPPS, CPHQ

New-onset confusion and functional decline are two possible symptoms  used to help diagnose UTI’s in catheterized LTC residents.  Yet these can be hard to isolate, especially in residents with baseline cognitive decline.  The downside of over-identifying possible UTI’s arises from two facts.  (1) When UTI is suspected, staff often ask for a urine culture, and (2) LTC residents often have asymptomatic bacteriuria:  bacteria that will show up in a urine culture but do not reflect an infection.  Once the culture shows bacteria to be present, providers treat the resident with antibiotics.  So, by fine-tuning the identification of cognitive conditions that might reflect the presence of a UTI, we could reduce the number of cultures performed and the treatment with antibiotics of positive cultures that don’t really indicate infection.

Recognizing this challenging situation, AHRQ has published a guide that discusses the best current information on possible behavior-based indicators in residents with baseline cognitive impairment, and it is available here.

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