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Research project

DISCO - DIagnoSing Care hOme UTI Study

Project overview

The number of care home residents is increasing and urinary tract infections (UTIs) are common amongst this group. Accurate diagnosis of UTI is important because not treating an infection may lead to serious consequences including death. However, giving antibiotic treatment when there isn’t an infection causes side effects and antibiotic resistance, making future infections harder to treat.

In care home residents, UTIs can cause symptoms like pain passing urine, needing to pass urine more often, or a change in smell or colour of the urine. However, they can just cause vague symptoms like confusion, loss of appetite, or problems with balance. Sometimes it can be hard to know what is causing the problem – especially for residents with dementia, who might not be able to communicate as easily or provide a urine sample to be tested. Many residents also have bacteria in their urine even when they are well (called asymptomatic bacteriuria) which does not need treatment with antibiotics. Currently available urine tests aren’t very helpful in this population. All these challenges mean that it is difficult to diagnose UTI accurately in care home residents. Residents often get given antibiotics ‘just in case’. Care home residents receive more antibiotics than older people living in their own homes, causing more side effects and antibiotic resistance.

To address this problem our team is developing new ways to accurately diagnose UTI. Approaches we want to evaluate include new urine ‘biomarker’ tests and working out which symptoms or signs most accurately predict UTI. To do this we want to conduct a large study collecting data and urine samples from care home residents with UTI. However, before we can do the bigger study we need to answer questions about the best way to do the study, and how big it needs to be – this is called a feasibility study.

For our feasibility study we plan to recruit 100 care home residents who will be followed up over 6 months. If residents with dementia lack the ability to consent, we will gain a declaration from a relative or care home staff member who knows them well. All 100 participants will provide information and a urine sample at the beginning of the study. 25 of these participants will also provide repeated weekly samples for 4 weeks to look at any changes in the urine over time. Additional information and urine samples will be collected if a participant develops a UTI during the study and any treatments will be recorded.

Our findings will be used to develop a funding application for a larger study aiming to improve the diagnosis of UTI in care home residents.


Lead researcher

Professor Nick Francis

Head of School

Research interests

  • Infections in primary care
  • Antimicrobial stewardship
  • Respiratory infections
Other researchers

Dr Mark Lown

Clinical Lecturer

Collaborating research institutes, centres and groups

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