Preventie, diagnostiek en behandeling van urineweginfecties bij bewoners in woonzorgcentra: een interdisciplinaire consensus vanuit de Vlaamse Hospital Outbreak Support Teams

Flemish consensus statement on the prevention, diagnosis and treatment of urinary tract infections in older nursing home residents Introduction: Urinary tract infections (UTIs) are one of the most commonly reported infections in Belgian nursing home (NH) residents. In older adults, UTI diagnosis and management is complex, often leading to over-diagnosis and irrational antimicrobial use. Methods: The Flemish Hospital Outbreak Support Teams developed a consensus statement on the prevention, diagnosis and treatment of UTIs in NH residents in collaboration with Flemish Agency for Care and Health, the Belgian Association of Urology, the Association of the Flemish Coordinating and Advising General Practitioners, the Belgian Society for Gerontology and Geriatrics, and PhD researchers in this topic, based on clinical expertise, (inter)national guidelines and peer-reviewed studies. Results: Optimizing fluid intake, appropriate toilet behaviour and posture, mobilization and vaginal estrogen therapy are of proven value in UTI prevention, whereas the use of cranberry products and probiotics is not to be advocated. The importance of avoiding bladder catheterization is stressed. In older residents, the diagnosis of UTIs remains challenging, mostly due to atypical systemic symptoms which can overlap with other conditions. Diagnostic flowcharts for UTI were developed, requiring a combination of suggestive clinical symptoms and a positive urine culture for a UTI diagnosis. Urine dipsticks have a high negative but a low positive predictive value; routine use is therefore not recommended. Asymptomatic bacteriuria should not be screened for, in order to avoid unnecessary triggers for treatment. In cystitis, nitrofurantoin is the primary choice for treatment, with fosfomycin as an alternative; in prostatitis and uncomplicated pyelonephritis a fluoroquinolone is the advocated empirical antimicrobial.