Developing a new approach to managing care home residents with possible urinary tract infection

Background:

The number of people living in nursing or residential care homes is increasing. People living in these settings are often frail and at risk of infections. Urinary tract infections (UTI) are very common in care home residents. However, there is a concern that UTI are over-diagnosed and over-treated in care home residents. This is because frail older people who develop new symptoms like weakness, loss of balance, increased confusion, or who have a change in the appearance or smell of their urine, are often treated as though they have a UTI. However, we don’t know whether people with these symptoms have a bacterial infection and/or benefit from antibiotic treatment. Unfortunately, testing for bacteria in the urine is not very helpful as many care home residents will ‘carry’ bacteria in their urine even when they do not have an infection or any symptoms.

We would like to test whether it is safe to avoid giving antibiotics to care home residents who develop these non-specific symptoms or changes to their urine. However, we first need to explore the views of care home staff and GPs about how to safely manage these patients without the initial use of antibiotics.

Aims:

Explore the views of care home staff and GP stakeholders on:

Which patients/residents with possible UTI could be safely managed without initial antibiotic treatment.

What testing and monitoring would be acceptable as an ‘enhanced surveillance’ safety net for patients/residents not initially treated with antibiotics.

Any other potential barriers or facilitators to conducting a trial comparing immediate antibiotic treatment with an ‘enhanced surveillance’ approach.

Methods:

This study will involve online focus group meetings and interviews with clinicians who provide clinical advice to care homes (GPs, paramedics, district nurse, frailty service, private providers) and interviews with care home staff (managers, nursing and caring staff). We aim to recruit participants from 2-4 care homes (including both nursing and residential homes). We will conduct interviews using the telephone or online voice or video calls. We will send sample materials, such as draft guidance or checklists, to participants prior to their focus group or interview so that they can provide feedback and use it as a focus for discussion. The focus groups and interviews will be recorded and transcribed, and then analysed using methods appropriate for qualitative research.

Patient and public involvement:

A care home nurse is supporting the study as a public contributor, and we will recruit a care home resident or relative as an additional public contributor.

Dissemination:

We will produce tools to help with the increased testing and monitoring. We will publish the results of our findings in medical journals. We will use the results to help develop a funding application to do a study where we compare an enhanced surveillance approach with immediate use of antibiotics in care home residents with possible UTI.

Amount awarded: £35,431