[ELDERLY HOSPITALIZED FEBRILE PATIENTS WITH A SUSPECTED URINARY TRACT INFECTION: DIAGNOSTIC AND THERAPEUTIC APPROACH]

Abstract

Since the urinary tract is thought to be one of the common sources of fever in hospitalized geriatric patients, urine analysis and urine cultures are routinely ordered in patients with and without urinary tract symptoms. The widespread lack of understanding of the uncertainties in the diagnosis and treatment of a symptomatic urinary tract infection (UTI) leads to unnecessary laboratory testing, and inappropriate antibiotic therapy. We present evidence for the following proposal that on the one hand will limit urine cultures and unnecessary antibiotic therapy without compromising patient safety and on the other hand will ensure proper antibiotic therapy. (1) Patients with extra-urinary sources for their fever should not have a urinalysis or urine culture. (2) In-and-out urinary catheterization procedures to obtain a sample should be limited (3) Patients without a positive dipstick test result do not need a urine culture in some settings. (4) A negative microscopic urinalysis after a positive dipstick test does not rule out a symptomatic UTI. (5) Febrile elderly patients without evidence of end organ damage can be followed-up carefully without antibiotic therapy. (6) Patients with septic shock require immediate antibiotic treatment with a carbapenem. It is unclear however, what to do with patients who have evidence of end organ damage variously defined. Whether these patients need immediate antibiotic treatment with or without coverage of ESBL-producing bacteria to decrease the risk for in-hospital mortality is an important question that requires randomized controlled studies.