Urine cultures from asymptomatic UK care home residents: early results from the DISCO UTI study

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

5D.5

Presenter:

Abi Moore

Twitter:

@DrAbigailMoore

Co-authors:

Nick Francis, Gail Hayward, Chris Butler, Margaret Glogowska, Mark Lown, Beth Stuart, Alastair Hay, Michael Moore, Paul Little, Mandy Wootton, Elizabeth Miles, Kristin Veighey, Chris Wilcox, Elizabeth Lydia

Author institutions:

University of Oxford, University of Southampton, University of Bristol, Queen Mary, University of London, Public Health Wales

Problem

The diagnosis and treatment of urinary tract infection (UTI) is particularly common amongst care home residents. However, establishing an accurate diagnosis is challenging in this population because: (i) symptoms and signs can be non-specific; (ii) histories can be unreliable due to cognitive impairment; (iii) obtaining an uncontaminated urine sample can be difficult; and (iv) there is a high prevalence of asymptomatic bacteriuria (ASB), estimated at 30-50% in this population. Research is urgently needed to address this problem. The aim of the DIagnoSing Care hOme UTI Study (DISCO UTI) is to assess feasibility and acceptability of conducting a prospective cohort study of urinary tract infections in care home residents and explore potential future diagnostic or prognostic strategies.

Approach

DISCO UTI is a cohort study of up to 100 care home residents, with a 6 month follow up. We are collecting baseline (asymptomatic) urine samples from all participants and repeated (asymptomatic) samples (weekly for 4 weeks) from a subset. Three further samples are sent during any possible UTI episodes during follow up. We will describe the urine samples in terms of appearance, microscopy and significant growth on culture and have included exploratory work on urinary biomarkers and novel point-of-care tests. There were two public co-applicants on the grant application, and our PPI group continues to contribute to the study. They informed discussion around the early design and management of the project and have had input on the participant facing materials.

Findings

We will be presenting findings from the baseline and weekly urine cultures. We have currently recruited 38 participants to the cohort from five care homes. Mean age of participants is 87.2 years. To date 37 baseline (asymptomatic) urine results are available. Only 2 of these samples (5%) show no growth. Fifteen samples (41%) meet the laboratory definition of UTI based on microscopy and culture. There are currently 35 weekly culture results from 12 asymptomatic participants. These appear to show weekly variation in bacterial growth. These results will be updated at the conference.

Consequences

Early indications suggest a larger, definitive cohort study could be feasible and that urine culture may not be diagnostically useful in the care home population. Alternative diagnostic strategies for care home UTI are being explored.

Submitted by:

Abi Moore

Funding acknowledgement:

This study is funded by the National Institute for Health Research School for Primary Care Research (Grant 578). Additional support is provided by Abigail Moore’s Wellcome Trust Doctoral Fellowship Grant, RCGP Scientific Foundation Board Grant and the NIHR Community Healthcare MedTech and IVD Cooperative (MIC).