In recent years, the number of nursing home beds has grown to exceed the number of hospital beds, a reflection of the aging of the U.S. population. Chronic urinary incontinence is present in up to 50% of nursing home patients. If other measures fail, a urine collecting device may be considered. For men, a condom catheter is associated with few complications; however, for women an analogous device Is not widely available. Consequently, especially for women, an Indwelling catheter may be used as a management technique for incontinence. We have studied complications of the long-term urethral catheter (greater than or equal to 30 days). In a stratified random sample of Maryland nursing homes, we found that 10% of almost 4,000 nursing home patients had a urinary catheter in place. Our microbiologic studies indicate that bacteriuria in these patient is universal, polymicrobial, and dynamic. Long-term catheter- associated bacteriuria appears to be the most common nosocomial infection in U.S. health care facilities. We have demonstrated complications to be fevers, bacteremias, urinary stones, acute pyelonephritis, chronic renal inflammation, and death. In this program, we prople four projects: 1) A course of study that is Intended to show why p. stuartii and p. mirabilis enjoy a niche in the long-term catheterized urinary tract, why these species are able to persist for long period of time there, and what virulence factors contribute to their pathogenesis. 2) The use of human renal tubular epithelial cell cultures, pyelonephritogenic strains of E. coli, and a mouse model of pyelonephritis to study the """"""""invasion"""""""" of the tubular epithelial cell as a critical step in the pathogenesis of acute pyelonephritis. 3) A prospective trial of the effectiveness, side effects, and incidence of bacteriuria complication of a prototype external urine collection device for incontinent formerly catheterized women. 4) A study examining two aspects of methodology in geriatric research: a) The adequacy of the proxy in representing the patient's viewpoint of clinical research in nursing homes; and b) a randomized trial of ante-mortem vs post-mortem consent for autopsy.
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