Topic: UTI prevention in hospitalized older adults

  

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https://doi.org/10.1177/1060028019886308

Annals of Pharmacotherapy
2020, Vol. 54(4) 359 –363
© The Author(s) 2019
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DOI: 10.1177/1060028019886308
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Research Report

Introduction

Urinary tract infections (UTIs) cause significant morbidity
and mortality in older adults, accounting for an estimated
15.5% of hospitalizations and 6.2% of infectious disease–
related deaths in patients 65 years and older.1 Among insti-
tutionalized adults, UTIs are the most common type of
infection and account for one-third of all infections.1 Older
adults are at higher risk for UTI because of increasing inci-
dence of urinary incontinence and retention, use of urinary
catheters, vaginal atrophy in postmenopausal women, long-
term institutionalization, and reduced immune function.1,2

Prophylactic antibiotics are often utilized in older
adults with recurrent UTIs. A retrospective cohort study
evaluated more than 19 000 patients ≥65 years old with
recurrent UTI who received prophylaxis with either trim-
ethoprim, cephalexin, or nitrofurantoin.3 Prophylaxis was
associated with a reduction in the risk of UTIs and UTI-
related hospitalizations.3

Currently, there are no treatment guidelines for the pre-
vention of recurrent UTIs. A major concern with use of
prophylactic antibiotics is antimicrobial resistance and
other adverse effects, including Clostridioides difficile.1
Antimicrobial resistance in community-acquired urinary
organisms is increasing in the United States. In nursing
home settings, colonization with multidrug-resistant organ-
isms is common.1

Methenamine is a Food and Drug Administration (FDA)-
approved medication used for the prevention of UTIs in
persons 6 years and older.4 The recommended dosing of

886308AOPXXX10.1177/1060028019886308Annals of PharmacotherapySnellings et al
research-article2019

1University of Colorado, Aurora, CO, USA

Corresponding Author:
Danielle R. Fixen, Department of Clinical Pharmacy, Skaggs School
of Pharmacy and Pharmaceutical Sciences, University of Colorado,
Anschutz Medical Campus Mail Stop C238, 12850 E Montview Blvd,
Aurora, CO 80045, USA.
Email: [email protected]

Effectiveness of Methenamine for UTI
Prevention in Older Adults

Marina S. Snellings, PharmD1, Sunny A. Linnebur, PharmD1,
Scott M. Pearson, PharmD1, Jeff I. Wallace, MD, MPH/MSPH1,
Joseph J. Saseen, PharmD1, and Danielle R. Fixen, PharmD1

Abstract
Background: Methenamine is a drug used for the prevention of lower urinary tract infections (UTIs). However, efficacy
has not been established in older adults or patients with varying degrees of kidney function. Objective: To evaluate the

Copyright © 2021 Society of Trauma Nurses. Unauthorized reproduction of this article is prohibited.

290 WWW.JOURNALOFTRAUMANURSING.COM Volume 28 | Number 5 | September-October 2021

R E S E A R C H

INTRODUCTION
Geriatric hip fracture patients are susceptible to a high-
er rate of complications, with rates ranging from 7% to
40% (Bliemel et al., 2017; Różańska, Wałaszek, Wolak, &
Bulanda, 2016; Thakker et al., 2018). One such complica-
tion is catheter-associated urinary tract infection (CAUTI).
Risk factors inherent to this population include surgical
procedures, immobility, age, and the routine utilization of
indwelling urinary catheters in the perioperative period
(Detweiler, Mayers, & Fletcher, 2015; Hälleberg Nyman
et al., 2013; Zielinski et al., 2015). This complication

negatively impacts both the patient and the institution
providing care.

It is reported that 15.5% of hospitalized patients older
than 65 years have urinary tract infections (UTIs) (Centers
for Disease Control and Prevention [CDC], 2019; Foxman,
2010). Moreover, 6.2% of infectious disease-related deaths
are due to UTIs (Alpay, Aykin, Korkmaz, Gulduren, &
Caglan, 2018). Implementation of various measures has
led to a reduction in the incidence of UTIs; however, UTIs
are still prevalent, placing an enormous financial burden
on institutions (Polites et al., 2014; Rebmann & Greene,
2010). The Centers for Medicare & Medicaid has deemed
that CAUTI is a “reasonably preventable” inhospital com-
plication and has terminated reimbursements for these
events since 2008 (CDC, 2019). The mean cost of UTI is
$862 to $1007 per UTI (Bail et al., 2015; CDC, 2019; Scott,
2010), whereas a systematic review found that the mean
cost of CAUTI can exceed $10,000 per CAUTI based on
the clinical status of the patient (Hollenbeak & Schilling,
2018).

A vast majority of patients who suffer hip fractures
undergo a surgical repair after admission (Bliemel et al.,
2017; Johnstone, Morgan, Wilkinson, & Chissell, 1995;
Wallace et al., 2019). These repairs have an elevated risk
of causing postoperative urinary retention due to the

ABSTRACT
Background: Catheter-associated urinary tract infection
(CAUTI) is a noted complication among geriatric hip fracture
patients. This complication results in negative outcomes
for both the patients and the institution providing care.
Screening measures to identify predisposing factors, with
early diagnosis and treatment of urinary tract infection (UTI)
present on admission, may lead to reduced rates of CAUTI.
Objective: The goals of this study were to determine the
prevalence of UTI on admission among geriatric hip fracture
patients and whether routine screening for UTI or predisposing
factors at presentation resulted in reduced rates of CAUTI.
Methods: A retrospective observational study of geriatric hip
f