Improving health care delivery for older adults requires investigation by both trained geriatricians and subspecialists with a geriatric focus. Infections in older adults are a common public health problem that lead to functional decline, mortality, and healthcare expenditures. Nursing home residents, in particular, are a vulnerable population in whom further investigation is warranted to optimize medical care. Urinary tract infection (DTI) in nursing home residents is an investigatively understudied topic. The primary goal of this application is to train Dr. Juthani-Mehta, the candidate, to be an investigative leader in geriatric infectious diseases and to advance multidisciplanary research in UTI in nursing home residents. The short-term goals of the career development plan are: 1) to establish the candidate as a patientoriented investigator at the interface of infectious diseases, geriatric medicine, and nursing home practice;2) to gain additional training and mentorship in chronic disease epidemiology, infectious diseases epidemiology, and longitudinal study design;and 3) to obtain skills in clinical trial design, geriatric medicine, and infection control methodology in nursing homes that will be necessary for future studies. The long-term goal is to train the candidate to be an investigative leader in the field of infections in older adults prepared to conduct multi-center observational and interventional clinical trials in long-term care facilities.
The specific aims of the research plan are: 1) to determine the reliability of UTI specific (e.g. flank pain or tenderness) and UTI non-specific (e.g., change in mental status) clinical features as assessed by nursing staff in nursing home residents with suspected UTI;2) to identify those reliable clinical features in residents with suspected UTI that are associated with laboratory evidence of UTI (i.e., bacteriuria plus pyuria) to create an evidencebased definition of UTI;and 3) to validate the combination of clinical features that are both reliable and associated with laboratory evidence of UTI in a separate validation cohort of nursing home residents with suspected UTI. The candidate is an emerging patient-oriented investigator with unique training in infectious diseases and geriatric clinical epidemiology that make her an ideal candidate to be among the investigative leaders in this field. The renowned mentors she has assembled and the environment at Yale University will allow for outstanding training and the successful completion of the proposed study.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Mentored Patient-Oriented Research Career Development Award (K23)
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National Institute on Aging Initial Review Group (NIA)
Program Officer
Salive, Marcel
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Yale University
Internal Medicine/Medicine
Schools of Medicine
New Haven
United States
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Rowe, Theresa Anne; Juthani-Mehta, Manisha (2014) Diagnosis and management of urinary tract infection in older adults. Infect Dis Clin North Am 28:75-89
Rowe, Theresa; Towle, Virginia; Van Ness, Peter H et al. (2013) Lack of positive association between falls and bacteriuria plus pyuria in older nursing home residents. J Am Geriatr Soc 61:653-4
Juthani-Mehta, Manisha; De Rekeneire, Nathalie; Allore, Heather et al. (2013) Modifiable risk factors for pneumonia requiring hospitalization of community-dwelling older adults: the Health, Aging, and Body Composition Study. J Am Geriatr Soc 61:1111-8
Das, Rituparna; Towle, Virginia; Van Ness, Peter H et al. (2011) Adverse outcomes in nursing home residents with increased episodes of observed bacteriuria. Infect Control Hosp Epidemiol 32:84-6
Juthani-Mehta, Manisha; Quagliarello, Vincent J (2010) Infectious diseases in the nursing home setting: challenges and opportunities for clinical investigation. Clin Infect Dis 51:931-6
Juthani-Mehta, Manisha; Perley, Lauren; Chen, Shu et al. (2010) Feasibility of cranberry capsule administration and clean-catch urine collection in long-term care residents. J Am Geriatr Soc 58:2028-30
Das, Rituparna; Perrelli, Eleanor; Towle, Virginia et al. (2009) Antimicrobial susceptibility of bacteria isolated from urine samples obtained from nursing home residents. Infect Control Hosp Epidemiol 30:1116-9
Juthani-Mehta, Manisha; Quagliarello, Vincent; Perrelli, Eleanor et al. (2009) Clinical features to identify urinary tract infection in nursing home residents: a cohort study. J Am Geriatr Soc 57:963-70
Juthani-Mehta, Manisha; Tinetti, Mary; Perrelli, Eleanor et al. (2008) Interobserver variability in the assessment of clinical criteria for suspected urinary tract infection in nursing home residents. Infect Control Hosp Epidemiol 29:446-9