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Master Thesis

Colonisations urinaires communautaires du sujet âgé en court séjour gériatrique du CHU Félix Guyon à Saint Denis de la Réunion : évaluation des pratiques professionnelles

Abstract : The urinary infection is one of the most frequent infectious problems in geriatrics. The elderly’s urinary infections are characterized by several favourable elements and by their often atypical and polymorphic symptomatology. The main objective of this study carried out during short geriatric stays, was to examine if the community urinary asymptomatic bacteriuria of the old people were treated in an excessive way or not. The other objectives of this study were to look for the clinical and para clinical criteria which influenced the antibiotic treatment of the urinary asymptomatic bacteriuria and to check if the local and national advice of the antibiotic treatment of the urinary infections were respected. It deals with a clinical epidemiology study of retrospective transverse observation made from one thousand and five CBEU and realized in the geriatric department from January 2012 to December 2013. We have found seventy-three potential urinary asymptomatic bacteriuria of community origin. The questionnaire included the reason for hospital entrance, the patient’s past facts, the private hospital, the blood biology, the x-rays done, the germ and its life last, the suggested antibiotic treatment, the research of an other infectious site and the final urinary infectious diagnosis. Among these potential asymptomatic bacteriuria we have diagnosed, on the one hand twenty-nine pyelonephritis, seven prostatitis and thirteen cystitis and on the other hand, we have diagnosed fourteen asymptomatic bacteriuria and ten contaminations. For these paucysymptomatic patients, the confusion, the biological criteria of inflammation and dehydration and the nature of the germ increased in a statistically significant way, the implementation of the antibiotic treatment (p<0,05). Compared with the recommendations of the SPILF and the HAS (except for the particular case of the métronidazole) the general concordance of the antibiotic treatment for all the urinary infections is around 69%. For the local recommendations, it is equal to 55%. (6, 21, 23) Even if, at present, there are no clinical criteria of diagnostic certainty for this kind of infection, the patients were treated essentially on clinical and biological criteria, (exactly as it is said in the new recommendations of the SPILF this year) taking care of the fragile old person, The criteria which were highlighted as having influenced the antibiotic treatment of the patients are not specific criteria but it is necessary to interpret them with caution, because in that population it is difficult to have a single infectious diagnosis, given the frequency of concomitant infections. As regards to the used antibiotic treatment, by not considering the métronidazole as a urinary antibiotic treatment choice, but as an antibiotic used to cure other infectious sites, the local recommendations, those of the SPILF, and thoseof the HAS are quite well respected, even if we can still improve the results, especially cure the cystitis.
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Master Thesis
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Submitted on : Monday, December 15, 2014 - 2:30:10 PM
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Antoine Moreau. Colonisations urinaires communautaires du sujet âgé en court séjour gériatrique du CHU Félix Guyon à Saint Denis de la Réunion : évaluation des pratiques professionnelles. Médecine humaine et pathologie. 2014. ⟨dumas-01095330⟩

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