Urinary tract infection in older adults

Abstract

Urinary tract infection and asymptomatic bacteriuria are common in older adults. Unlike in younger adults, distinguishing symptomatic urinary tract infection from asymptomatic bacteriuria is problematic, as older adults, particularly those living in long-term care facilities, are less likely to present with localized genitourinary symptoms. Consensus guidelines have been published to assist clinicians with diagnosis and treatment of urinary tract infection; however, a single evidence-based approach to diagnosis of urinary tract infection does not exist. In the absence of a gold standard definition of urinary tract infection that clinicians agree upon, overtreatment with antibiotics for suspected urinary tract infection remains a significant problem, and leads to a variety of negative consequences including the development of multidrug-resistant organisms. Future studies improving the diagnostic accuracy of urinary tract infections are needed. This review will cover the prevalence, diagnosis and diagnostic challenges, management, and prevention of urinary tract infection and asymptomatic bacteriuria in older adults.

Keywords: aging; asymptomatic bacteriuria; elderly; urinary tract infection.

Figure 1. Diagnostic algorithm for urinary tract infection in long-term care facilities in residents without an indwelling catheter

^†Change in color or odor of urine. ^‡Change in level of consciousness, periods of altered perception, disorganized speech or lethargy. ^§Single temperature ≥37.8°C (>100°F) or >37.2°C (>99°F) on repeated occasions, or an increase of >1.1°C (>2°C) over baseline. ^¶Leukocytosis: >14,000 cells/mm³ or left shift >6% or 1500 bands/mm³. WBC: White blood cell.