# Retrospective analysis of urinary tract infections in long-term care facilities in Japan: Insights from physical examination-based diagnosis

## TL;DR

This study analyzed urinary tract infections in Japanese long-term care facilities, finding high rates of multidrug-resistant bacteria and highlighting the need for better antimicrobial stewardship.

## Contribution

The study provides new insights into the prevalence and treatment of multidrug-resistant UTIs in Japanese LTCFs using physician-based diagnoses.

## Key findings

- Multidrug-resistant organisms were frequently detected, with Escherichia coli being the most common.
- Initial antimicrobial agents were less effective against MDR pathogens but were often continued regardless of culture results.
- No significant differences in clinical outcomes were observed between MDR and non-MDR groups.

## Abstract

Multidrug-resistant (MDR) bacterial infections are highly prevalent among long-term care facility (LTCF) residents, and are thus important targets for antimicrobial stewardship. Diagnoses of urinary tract infections (UTIs), which are associated with antimicrobial use in these facilities, are not always made by physicians. Past epidemiologic studies have included asymptomatic bacteriuria together with UTIs. The National Healthcare Safety Network has initiated a surveillance program to identify the causative organisms of UTIs in LTCF residents. In Japan, medical care for these residents is provided through in-person physician visits; however, limited related data are available. Therefore, we investigated the organisms causing UTIs and their drug susceptibility among LTCF residents in central Japan, and examined the prevalence of multidrug resistance, its risk factors, and correlations with clinical outcomes.

We retrospectively evaluated clinical and urine culture data of LTCF residents with physician-diagnosed UTIs between April 1, 2019, and April 30, 2022.

The detection rate of multidrug-resistant organisms was high, with Escherichia coli being the most prevalent. Ceftriaxone was frequently used for initial therapy. The initial antimicrobial agents were significantly less active against MDR pathogens than non-MDR pathogens. Most residents continued to receive the initial agents regardless of culture results. Nonetheless, differences in the therapy duration, relapse and hospitalization rates, and death rate within 28 days between the multidrug-resistant and non–multidrug-resistant groups were not significant.

Antimicrobial stewardship is essential for reducing antimicrobial use and selective pressure in LTCFs in Japan; however, more specific data are needed for its effective implementation.