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Villasanta, Italy

Ricci G.,RSA Villa San Clemente | Cosso P.,RSA Villa San Clemente | Pagliari P.,RSA Villa San Clemente | Ianes A.B.,Direzione Medica
Giornale di Gerontologia | Year: 2010

Lower urinary tract infections (LUTIs) represent, with lower respiratory tract infections, the most common infections in geriatric population. Their diagnosis and treatment have implications for the health of patients, for the development of antibiotic resistance and for the costs associated with the diagnosis and therapy. Given the frequency of LUTIs, we wanted to check what are, in elderly patients living in nursing home, the most frequent pathogens of lower urinary tract infection. We performed an observational study by monitoring LUTIs in elderly people living in RSA Villa San Clemente, a 110 beds nursing home (Villasanta, MB). During the 54 months of follow up, we collected urine specimens within the first 48 hours from the admission, in case of urinary symptoms or, in the absence of symptoms, whenever it should become necessary a control of blood chemistry (at least once every 6 months) and urinary culture were obtained. During the follow up 708 positive urinary cultures in 185 subjects (mean age = 84,05 ± 7.72 years) were recorded; we registered 382 urinary infections in 139 women (253 = asymptomatic batteriuria) and 170 urinary infections in 46 men (73 = asymptomatic batteriuria). Gram negative strains were the most frequently isolated: Escherichia Coli (57.20%), Proteus Mirabilis (12.99%), Klebsiella Pneumoniae (9.60%), Pseudomonas Aeruginosa (4.09%). Among the gram positive strains, the more frequently isolated were Group D Streptococcus (1.84%), Enterococcus Faecalis (1.27%) and Coagulase Positive Staphylococcus (1.13%). Our data are consistent with those of the literature and confirm the importance of the surveillance of LUTIs also in nursing homes to identify subjects with symptomatic LUTIs or asymptomatic batteriuria, to better manage pharmaceutical expenditure avoiding inappropriate antibiotic treatment, and simultaneously treat symptomatic subjects to reduce the prevalence of recurrent infections and mortality in frail elderly.

Introduction. Pain is a widespread condition among Nursing Home residents, but is under diagnosed and undertreated. Aim of the study was to evaluate, in ten nursing homes of Segesta, Korian Group, the willingness to recognize and to treat the symptom pain, testing the most commonly used molecules for the treatment of pain. We evaluated in a sample of nursing home residents, socio-demographic characteristics (sex, age and years of education), cognitive performance, affective disorders and diseases according to the 14 classes of Cumulative Illness Rating Scale. We further investigated chronic analgesic therapies (> 30 days), acute (< 30 days) and the most commonly molecules used as painkillers. Results. 1053 subjects were evaluated mainly represented by women [F = 800; (76%)], with a mean age of 83.45 ± 9.36, a 7.68 ± 4.10 years education and severe somatic co-morbidity. Pain treatment affected 306/1053 residents (29,1%), with a strong use of medicines as needed (25.2%). Chronic therapy involved the 12.8% of the subjects, the “acute” 4.5%. The most commonly used medication was acetaminophen, either in monotherapy (82.02%) than in pre-conceived association (18.94%), followed by opiates (22.54%) and NSAIDs (12,09%). Conclusions. Our data have confirmed the undertreatment of pain, especially in persistent pain. These data are in line with those of the literature. The most commonly used drugs were acetaminophen and opioids, limited the use of NSAIDs, while negligible the use of COX2 inhibitors. © 2014, Pacini Editore S.p.A. All rights reserved.

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.

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