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The University of Southampton
Medicine

Research project: VENUS Study – Developing a new approach to managing care home residents with possible urinary tract infection 

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The number of people living in nursing or residential care homes is increasing. People living in these settings are often frail and at risk of infections. Urinary tract infections (UTI) are very common in care home residents. However, there is a concern that UTI are over-diagnosed and over-treated in care home residents. This is because frail older people who develop new symptoms like weakness, loss of balance, increased confusion, or who have a change in the appearance or smell of their urine, are often treated as though they have a UTI. However, we don’t know whether people with these symptoms have a bacterial infection and/or benefit from antibiotic treatment. Unfortunately, testing for bacteria in the urine is not very helpful as many care home residents will ‘carry’ bacteria in their urine even when they do not have an infection or any symptoms.

We would like to test whether it is safe to avoid giving antibiotics to care home residents who develop these non-specific symptoms or changes to their urine. However, we first need to explore the views of care home staff and GPs about how to safely manage these patients without the initial use of antibiotics.

Aims

Explore the views of care home staff and GP stakeholders on:

  1. The design of a trial of antibiotics for care home residents with suspected UTI, including blinding, inclusion criteria and outcomes.
  2. What testing and monitoring would be acceptable as an ‘enhanced surveillance’ safety net for patients/residents not initially treated with antibiotics.
  3. Any other potential barriers or facilitators to conducting a trial comparing immediate antibiotic treatment with an ‘enhanced surveillance’ approach.

Methods

This study will involve online interviews with clinicians who provide clinical advice to care homes (GPs, paramedics, district nurse, frailty service, private providers) and interviews with care home staff (managers, nursing and caring staff). We aim to recruit participants from 2-4 care homes (including both nursing and residential homes). We will conduct interviews using the telephone or online voice or video calls. We will send sample materials, such as draft guidance or checklists, to participants prior to their focus group or interview so that they can provide feedback and use it as a focus for discussion. The focus groups and interviews will be recorded and transcribed, and then analysed using methods appropriate for qualitative research. 
 
Patient and public involvement

A care home nurse is supporting the study as a public contributor, and we will recruit a care home resident or relative as an additional public contributor. 
 
Dissemination

We will produce tools to help with the increased testing and monitoring. We will publish the results of our findings in medical journals. We will use the results to help develop a funding application to do a study where we compare an enhanced surveillance approach with immediate use of antibiotics in care home residents with possible UTI. 
 
Lead Investigator: Prof Nick Francis
Co-applicants: Dr Mark Lown, Dr Ingrid Muller, Prof Michael Moore, Prof Paul Little, Dr Christopher Wilcox
Collaborators: Dr Gail Hayward, Dr Abigail Moore
PPI collaborators: Debbie Fosset, Clinical Lead, Harry Sotnick House 
  
Funder: NIHR School for Primary Care Research, project no. 533
Duration: 1 Dec 2021-31 November 2022 
ContactNick.Francis@soton.ac.uk
 
This study is being conducted by the Primary Care Research Centre

Research themes

Content areas

  • Infections and antibiotics
  • Health ageing

Related research groups

Primary Care, Population Sciences and Medical Education
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