Bacteriuria in Elderly Institutionalized Men

Over a two-year period we obtained monthly urine samples from all noncatheterized male residents on two geriatric wards to determine the occurrence and optimal management of bacteriuria in this population. Among 88 men the prevalence of bacteriuria was 33 per cent, and the incidence was 45 infections per 100 patients per year. Outcomes after single-dose therapy for asymptomatic bacteriuria with 43 courses of trimethoprim/sulfamethoxazole and 23 of tobramycin included 15 cures, 40 relapses, and 11 treatment failures. Thirty-six residents who had a relapse or in whom single-dose therapy failed were randomly assigned to receive therapy to eradicate bacteriuria or to receive no therapy. All 20 residents who received no therapy remained bacteriuric. The 16 residents who received therapy had fewer months of bacteriuria after randomization, but at the end of the study only one remained free of bacteriuria. Mortality and infectious morbidity after randomization were similar in the two groups. These data suggest that asymptomatic bacteriuria is common in elderly Institutionalized men and that therapy is neither necessary nor effective. (N Engl J Med 1983; 309:1420–5.) THE prevalence of bacteriuria increases with advancing age, and in the elderly the prevalence also increases with advancing functional disability. 1 , 2 In the elderly nursing-home population, 20 to 50 per cent of both male and female residents will have bacteriuria. 1 Despite the high frequency with which it occurs, the bacteriuria in this group remains poorly characterized. The site of infection within the urinary tract is not well defined, and the natural history of bacteriuria and its contribution, if any, to morbidity are unknown. Some authors have reported decreased renal function in association with bacteriuria, 3 but other studies 4 5 6 do not support this . . .