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Review
. 2017 Dec;31(4):673-688.
doi: 10.1016/j.idc.2017.07.002.

Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults

Nicolas W Cortes-Penfield  1 , Barbara W Trautner  2 , Robin L P Jump  3
Affiliations
Review

Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults

Nicolas W Cortes-Penfield et al. Infect Dis Clin North Am. 2017 Dec.

Abstract

Urinary tract infections (UTIs) are a significant cause of morbidity among older adults. However, antibiotic prescriptions for clinically suspected UTIs are often inappropriate. Health care providers frequently struggle to differentiate UTI from asymptomatic bacteriuria, particularly in patients presenting with nonspecific symptoms. Patients with baseline cognitive impairments that limit history-taking can be particularly challenging. This article reviews the epidemiology and pathogenesis of UTI in older adults. It discusses an approach to diagnosis and treatment focused on recognizing patients who would likely benefit from antibiotic treatment and on identifying patients for whom empiric antibiotic therapy should not be given.

Keywords: Asymptomatic bacteriuria; Older adults; Urinary tract infection.

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Figures

Figure 1
Figure 1. Algorithmic approach to diagnosing ASB and Possible, Probable or Definite UTI
1dysuria, frequency, suprapubic pain, gross hematuria, costovertebral angle tenderness, or new or worsening urgency or urinary incontinence 2fever, rigors, or clear-cut delirium 3>10 WBCs per high powered field on microscopy or positive leukocyte esterase 4Fever, sepsis (abnormal SIRS or qSOFA), or acute illness requiring ICU care *UTI can still be considered in patients with neutropenia or other conditions that might cause the absence of pyuria **Urine cultures may be negative if obtained after the patient has received antibiotics; in such cases, stop antibiotics given specifically for UTI if the patient’s clinical condition is not improving
See this image and copyright information in PMC

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