{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:06:35Z","timestamp":1792112795310,"version":"4.4.0"},"reference-count":19,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,1,11]],"date-time":"2013-01-11T00:00:00Z","timestamp":1357862400000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"NIH-NIA"},{"name":"NIH-NIA R01","award":["AG032982"],"award-info":[{"award-number":["AG032982"]}]},{"name":"NIH-NIA R01","award":["K24AG033640"],"award-info":[{"award-number":["K24AG033640"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2013,1]]},"abstract":"\n Objectives<\/jats:title>\n \n To describe the presentation of suspected urinary tract infections (\n UTI<\/jats:styled-content>\n s) in nursing home (\n NH<\/jats:styled-content>\n ) residents with advanced dementia and how they align with minimum criteria to justify antimicrobial initiation.\n <\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Twelve\u2010month prospective study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n \n Twenty\u2010five\n NH<\/jats:styled-content>\n s.\n <\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n \n Two hundred sixty\u2010six\n NH<\/jats:styled-content>\n residents with advanced dementia.\n <\/jats:p>\n <\/jats:sec>\n \n Measurements<\/jats:title>\n \n Charts were abstracted monthly for documentation of suspected\n UTI<\/jats:styled-content>\n episodes to determine whether episodes met minimum criteria to initiate antimicrobial therapy according to consensus guidelines.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Seventy\u2010two residents experienced 131 suspected\n UTI<\/jats:styled-content>\n episodes. Presenting symptoms and signs for these episodes are mental status change (44.3%), fever (20.6%), hematuria (6.9%), dysuria (3.8%), costovertebral tenderness (2.3%), urinary frequency (1.5%), rigor (1.5%), urgency (0%), and suprapubic pain (0%). Only 21 (16.0%) episodes met minimal criteria to initiate antimicrobial therapy based on signs and symptoms. Of the 110 episodes that lacked minimum criteria to justify antimicrobial initiation, 82 (74.5%) were treated with antimicrobial therapy. Urinalyses and urine culture results were available for 101 episodes, of which 80 (79.2%) had positive results on both tests. The proportion of episodes with a positive urinalysis and culture was similar for those that met (83.3%) and did not meet (78.3%) minimum criteria (\n P<\/jats:italic>\n \u00a0=\u00a0.06).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n The symptoms and signs necessary to meet minimum criteria to support antimicrobial initiation for\n UTI<\/jats:styled-content>\n s are frequently absent in\n NH<\/jats:styled-content>\n residents with advanced dementia. Antimicrobial therapy is prescribed for the majority of suspected\n UTI<\/jats:styled-content>\n s that do not meet these minimum criteria. Urine specimens are frequently positive regardless of symptoms. These observations underscore the need to reconsider the diagnosis and the initiation of treatment for suspected\n UTI<\/jats:styled-content>\n s in advanced dementia.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jgs.12070","type":"journal-article","created":{"date-parts":[[2013,1,11]],"date-time":"2013-01-11T13:56:29Z","timestamp":1357912589000},"page":"62-66","source":"Crossref","is-referenced-by-count":165,"title":["Challenges in Assessing Nursing Home Residents with Advanced Dementia for Suspected Urinary Tract Infections"],"prefix":"10.1111","volume":"61","author":[{"given":"Erika D'","family":"Agata","sequence":"first","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark B.","family":"Loeb","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Medicine McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts"},{"name":"Hebrew Senior Life Institute for Aging Research Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,1,11]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-011-1504-7"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-2-17"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365540701745279"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkr395"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016006376.x"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1086\/427507"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.60.8.1119"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.139.9.1136"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2007.104"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2008.01787.x"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1086\/501875"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/49.5.M223"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta13190"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1086\/650482"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1086\/595683"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2009.04.006"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2009.02227.x"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0902234"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1086\/430314"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjgs.12070","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjgs.12070","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.12070","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T14:42:10Z","timestamp":1762180930000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.12070"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,1]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2013,1]]}},"alternative-id":["10.1111\/jgs.12070"],"URL":"https:\/\/doi.org\/10.1111\/jgs.12070","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,1]]}}}