Optimal management of urinary tract infections in older people

Abstract

Urinary tract infections (UTI) occur frequently in older people. Unfortunately, UTI is commonly overdiagnosed and overtreated on the basis of nonspecific clinical signs and symptoms. The diagnosis of a UTI in the older patient requires the presence of new urinary symptoms, with or without systemic symptoms. Urinalysis is commonly used to diagnose infection in this population, however, the evidence for its use is limited. There is overwhelming evidence that asymptomatic bacteriuria should not be treated. Catheter associated urinary tract infection accounts for a significant amount of hospital-associated infection. Indwelling urinary catheters should be avoided where possible and alternatives sought. The use of narrow spectrum antimicrobial agents for urinary tract infection is advocated. Local guidelines are now widely used to reflect local resistance patterns and available agents. Guidelines need to be updated to reflect changes in antimicrobial prescribing and a move from broad to narrow spectrum antimicrobials.

Keywords: elderly; review; urinary tract infection.

Figure 1

Negative predictive value (NPV) and positive predictive value (PPV) for dipstick urine testing for diagnosis of bacteriuria in a nursing home population. Test characteristics of a positive leukocyte esterase and/or a positive nitrite dipstick were compared to urine culture. These results were for visual reading of the dipstick; results with analyzer reading were almost identical. Data adapted from Sundvall and Gunnarsson.