Most urinary tract infections can be treated in place at a skilled nursing facility, but several clinical data points can help guide a nursing home’s transfer decisions, reported researchers at the Indiana University Center for Aging Research at Regenstrief Institute.

They examined data on 307 nursing home residents diagnosed with a UTI between October 1, 2016, and September 30, 2018. The majority of these residents — 241 of them in fact — were able to be treated in place, while 66 were hospitalized. Results showed that White residents were more frequently treated in place than Black residents, and that hypertension was more frequently identified in hospitalized residents. Outside of that, however, researchers found no significant differences in age, sex, functional status or other comorbidities between residents hospitalized or treated in place for a UTI.

What mattered most, perhaps expectedly, were that residents who were transferred to the hospital appeared to be more acutely ill than those who were treated in place. Residents with UTIs treated in place were more likely to have dysuria and increased urinary frequency than those hospitalized, whereas hospitalized residents had more rapid breathing and tachycardia than those treated in place. Altered mental status was the most frequently reported sign prompting evaluation for UTI (34%). Of 229 residents with altered mental status, 124 had no other signs, three had hypothermia, and seven had fever, researchers reported.

Residents also differed in the treatments they received, according to the study. Despite the fact that nitrofurantoin is recommended as a first-line treatment for UTI in nursing homes, fluoroquinolones and sulfonamides used most frequently among those treated in place, and third-generation cephalosporins were most commonly used with hospitalized residents. 

Overall however, the lack of complete data about vital signs concerned the researchers, and they urged facilities to optimize their documentation and monitoring of resident vital signs when it comes to UTIs.

“Improvements in automating the monitoring, documentation and alerting of vital signs and sepsis screening may help in identifying patients who would benefit from hospitalization,” the authors concluded. 

Results are available in JAMDA