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

<h3>Context.</h3> 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 due to: (i) non-specific symptoms and signs; (ii) cognitive impairment; (iii) difficulties obtaining an uncontaminated urine sample; and (iv) high prevalence of asymptomatic bacteriuria (ASB), estimated at 30-50% in this population. Research is urgently needed to address this problem. <h3>Objective.</h3> 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. <h3>Study Design and Analysis.</h3> 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. <h3>Population Studied.</h3> Care home residents, aged 65 and over. <h3>Outcome Measures.</h3> 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. <h3>Results.</h3> We will be presenting findings from the baseline and weekly urine cultures. We have currently recruited 69 participants from eight care homes. Mean age of participants is 85.7 years. To date 62 baseline (asymptomatic) urine results are available. Only 6 of these samples (10%) show no growth. 21 samples (34%) meet the laboratory definition of UTI based on microscopy and culture. There are currently weekly culture results from 22 asymptomatic participants, which appear to show weekly variation in bacterial growth. These results will be updated at the conference. <h3>Conclusions.</h3> 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.